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Monday 11th June 4-5pm PDT

crowd.cochrane.org

Support for Project Transform was provided by Cochrane and the National Health and Medical Research Counc12/12/1996il 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.

There is no RCT evidence available to guide how best to investigate the causes of stillbirth – future trials are needed.

Identification of the causes of stillbirth is critical to the primary prevention of stillbirth and to the provision of optimal care in subsequent pregnancies. A wide variety of investigations are available, but there is currently no consensus on the optimal approach. Given their cost and potential to add further emotional burden to parents, there is a need to systematically assess the effect of these interventions on outcomes for parents, including psychosocial outcomes, economic costs, and on rates of diagnosis of the causes of stillbirth.

A team of Cochrane authors based in Australia, Netherlands, and United States worked with Cochrane Pregnancy and Childbirth to assess the effect of different tests, protocols or guidelines for investigating and identifying the causes of stillbirth on outcomes for parents, including psychosocial outcomes, economic costs, and rates of diagnosis of the causes of stillbirth. The Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) were searched. There were no eligible trials for inclusion in this review.

“Searching for causes of stillbirth can be difficult emotionally for families, and financially costly to health services and sometimes to parent,” says Ms Aleena M Wojcieszek, lead author of the Cochrane Review from NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland. “There is a need to assess systematically which approaches are most helpful in finding causes of stillbirth, how cost-effective the different approaches are, what the emotional and social effects on parents are, what impact the investigations have on future pregnancies, and the end result of future pregnancies.”

Dr. Katherine J Gold, Cochrane Review author from Deptartment of Family Medicine at the University of Michigan, added, “Future trials on this topic would be helpful, but such trials would need to be designed in a way that ensures all parents in the trial still receive the minimum standard of care in their local setting. Future trials would need to be conducted with the utmost care and consideration for the needs, concerns, and values of parents and families." Adding to this, Professor Vicki Flenady, senior author and Director of the Centre of Research Excellence in Stillbirth commented,  "Assessment of longer-term psychosocial variables, economic costs to health services, and effects on subsequent pregnancy care and outcomes should be considered in any future trials.”

Video from the University of Michigan Family Medicine

• Read the full Cochrane Review
• Visit the Cochrane Pregnancy and Childbirth website

Labouring in water may reduce the number of women having an epidural but does not appear to affect mode of birth or serious perineal tears.

Water immersion during labour and birth is increasingly popular and is becoming widely accepted across many countries, and particularly in midwifery-led care settings. However, there are concerns around neonatal water inhalation, increased requirement for admission to neonatal intensive care unit (NICU), maternal and/or neonatal infection, and obstetric anal sphincter injuries (OASIS).

A team of Cochrane authors based in the United Kingdom worked with Cochrane Pregnancy and Childbirth to update the 2011 Cochrane Review assessing the effects of water immersion during labour and/or birth (first, second and third stage of labour) on women and their infants. This review includes 15 trials conducted between 1990 and 2015 with a total of 3663 women.

Labouring in water may reduce the number of women having an epidural. Giving birth in water did not appear to affect mode of birth, or the number of women having a serious perineal tear. This review found no evidence that labouring in water increases the risk of an adverse outcome for women or their newborns. The trials varied in quality and further research is needed particularly for waterbirth and its use in birth settings outside hospital labour wards before we can be more certain of these effects. Research is also needed about women’s and caregivers experiences of labour and birth in water.

“Immersion in water during labour and waterbirth facilitates physiological labour and birth, offers women a non-pharmacological pain relief option and facilitates a sense of choice, control and comfort; qualities strongly associated with women’s satisfaction with their birth experience,” says Dr Elizabeth R Cluett, the lead author of the Cochrane Review. “Labouring and/or giving birth in water may enable healthy women who have a straightforward pregnancy to have fewer interventions leading to a spontaneous birth and provides them a choice that is available in all birth settings”

Dr. Ethel Burns, Cochrane Review author added, “An extensive search review and selection process was completed and 3 new trials that meet the Cochrane criteria on this topic were added to this update. We hope that more research will be conducted in birthing settings outside of hospital labour wards for the next update of this important Cochrane Review” 

• Read the full Cochrane Review
• Visit the Cochrane Pregnancy and Childbirth website

Governance Meetings are Cochrane’s annual business meetings. We are looking for a Cochrane Groups to host the 2020 and 2021 events.

Cochrane Governance Meetings are an opportunity for the Cochrane’s Governing Board, Councils, and Executives to meet and discuss the organization’s Strategy to 2020 and related targets, and how these are being developed and implemented. From the 1-5 April 2019, Cochrane Poland will be hosting the event in Krakow.

It is important to note that Cochrane Governance Meetings are usually held in Europe, where the location should be within two hours’ travelling time of an international airport; but they can also be held elsewhere in the world, though at an easily accessible transport hub.

Find out more about the criteria for hosting a Governance Meetings and how to apply. 

Governance Meeting hosts are given support from the Cochrane Executive Team throughout the organization and hosting of the event.

The deadline for submissions is Monday 30 July 2018.

Governance Meetings are Cochrane’s annual business meetings. We are looking for a Cochrane Groups to host the 2020 and 2021 events.

Cochrane Governance Meetings are an opportunity for the Cochrane’s Governing Board, Councils, and Executives to meet and discuss the organization’s Strategy to 2020 and related targets, and how these are being developed and implemented. From the 1-5 April 2019, Cochrane Poland will be hosting the event in Krakow.

It is important to note that Cochrane Governance Meetings must be held in Europe or an easily accessible transport hub. At a minimum, the location should be within two hours’ travelling time of an international airport.

Find out more about the criteria for hosting a Governance Meetings and how to apply. 

Governance Meeting hosts are given support from the Cochrane Executive Team throughout the organization and hosting of the event.

The deadline for submissions is Monday 30 July 2018.

Specifications: Full Time
Salary: Competitive
Location: London, UK
Application Closing Date: 25 may 2018

This role is an exciting opportunity to use your experience in Product Management to make a difference in the field of health care research.  

The Product Manager will own the Cochrane Library as a product through its lifecycle and ensure its ongoing technological and content development to meet identified user needs. They will be responsible for contributing to and implementing key elements of the strategic vision for the Cochrane Library, and be responsible for the overall success of the development pipeline for the product.

The successful candidate will act as a ‘champion’ for the Cochrane Library within the organisation. They will be responsible for taking the lead in the product market and ensuring a strategic fit between the market environment, the organisation’s capabilities, business needs and the product marketing strategy.

We are looking for a self-motivated and highly organised individual who is able to work effectively and collaboratively with a diverse range of contacts across the world.  The successful candidate will also have:

• Publishing experience in scientific and medical publications and awareness of health knowledge and decision support products.
• Minimum 3 years direct product management experience.
• Demonstrated track record in developing product strategies and success in defining, launching and managing products.
• Detailed knowledge of the mission and vision of Cochrane Library and in-depth understanding of the needs of its users and the processes that underpin its production.
• Proven ability to make decisions, think strategically and take senior-level responsibility
• IT literacy and the ability to gain an understanding of the technological aspects of the product, both in terms of its production and publication
• Influencing and negotiation skills, sufficient to coordinate work undertaken by other stakeholders and cross-functional teams in the development cycle
• Very strong communication and presentation skills, and the ability to translate content deliverables to business and technology focussed colleagues
• Ability to analyse, pull together and present the key content, business and technology elements to inform sound strategic decisions
• Strong project and programme management skills.

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with “Product Manager” in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

For further information, please download the full job description.

Deadline for applications: 25 May 2018 (12 midnight GMT)
 
Interviews to be held on: w/c 4 July 2018

Job Title: Interim Translations Co-ordinator
Type of contract: Fixed term, June 2018 to January 2019
Location: Flexible

The Interim Translation Co-ordinator ensures the successful delivery of the Cochrane’s translation strategy and work plan as part of Cochrane’s Strategy to 2020 targets and goals and the Knowledge Translation (KT) Framework under the direction of the Head of KT. This person represents translation and multi-language needs across Cochrane’s Central Executive departments to ensure they are taken into account and implemented within editorial, communication and technological developments; coordinates the maintenance and development of infrastructure and processes for translation; oversees and supports all translation projects; and represents translation and multi-language matters within Cochrane as well as externally.

Key Result Areas

Work closely with, and facilitate communication between Cochrane’s Central Executive, translation project teams, and Cochrane’s publisher, John Wiley & Sons, to:

• Take overall responsibility for the day-to-day operations required to deliver the translation strategy as part of Cochrane’s Strategy to 2020 and KT Framework;
• Ensure the implementation of multi-language approaches as part of the wider KT implementation, help coordinate the responsible working group and deliver its workplan;
• Oversee, support and engage with all on-going and planned translation projects;
• Train and support translation project teams with their translation and dissemination activities to ensure effectiveness and quality;
• Act as product owner and subject matter expert to develop and maintain multi-language functionality in all of Cochrane’s processes and products, including the Cochrane Library, cochrane.org, Archie, Sugar CRM, editorial and organisational processes;
• Maintain and develop the Translation Management System (TMS) integration with Memsource, to take into account user feedback and improve usability;
• Coordinate the review and adaption of Cochrane’s translation strategy.

• Background in translation, linguistics, communications or a related field;
• Excellent working proficiency in English and working proficiency in at least one other language; additional languages are an advantage;
• Verifiable competence and willingness to establish and maintain effective working relations with people from a variety of cultural and linguistic backgrounds and geographically dispersed teams;
• Ability to work independently and accountably under general direction, and to provide sound advice and support to others;
• Excellent interpersonal and communication skills (spoken, written and presentational) and a collaborative management style;
• Proven project management and organisational skills; and the ability to coordinate the work of teams and individuals, ensuring the quality and timeliness of outputs.
• Working experience or knowledge in content localisation and related matters including multi-language search and communications.
• Technological knowledge, comfortable using specialised software and dealing with technical issues;
• Time management skills, ability to work to deadlines and flexible hours as needed; 
• Ability to travel internationally on an occasional basis.

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with “Interim Translations Co-ordinator” in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

For further information, please download the full job description.
Deadline for applications:  Wednesday 23th May 2018 (12 midnight GMT)

Salary: Competitive
Location: Flexible, London, UK preferred
Position: Permanent, full time

This role will be responsible for leading and managing Cochrane’s multi-media and external communications to raise the profile and impact of Cochrane and evidence informed healthcare, and to support the organization’s strategic and knowledge translation aims and operational activities.

Key Result Areas:

• To coordinate the development and maintenance of Cochrane’s external communications, media outreach and multi-media relations on behalf of Cochrane’s Central Executive Team and wider Community/stakeholders.
• To contribute to the implementation of Cochrane’s Knowledge Translations Strategy within the thematic area of ‘packaging and push,’ which describes a programme of work bridging production, dissemination and support to implementation through creating fit for purpose reviews and disseminating these effectively.
• To contribute to the development of improving Cochrane’s existing and new Knowledge Translation products and processes in line with the KT implementation plan.
• To ensure our communications and content is customized to the needs of end-users of Cochrane’s evidence.
• To work alongside Cochrane’s community Groups worldwide to assist them in producing multi-media based content and building their external communications and social media strategies.
• To work, establish and build new relationships with Cochrane authors and Review Groups and Networks to support, mentor and enhance their communications and multi- media content.
• To establish new, and maintain relationships with key international media outlets, health and science correspondents, journalists, producers and editors.
• To write, as required, materials for the purposes of print, broadcast, web and social media.
• To monitor and report Cochrane’s media coverage and make recommendations to maintain an evidence-based approach to our communications and social media strategy.
• To work as part of a core Central Executive team to create multi-media campaigns, online content, press releases, spokesperson statements and other KT audience-focused resources.
• To act as main focal point for all reactive media requests and manage them effectively and efficiently.

Person Specification:

• A degree or equivalent experience working within an external communications or multi-media content environment, journalism, and/or in a similar role.
• Demonstrable experience of advising and implementing a media, multi-media media and communications strategy in conjunction with others; and proven success in communicating the vision and mission of an organization.
•    Proven ability to manage multiple projects and work assignments.
•    Proven ability to work alongside varied teams in different cultural and linguistic settings.
•    Impressive interpersonal skills both in person and through teleconferences and webinars.
•    An excellent understanding of multi-media platforms and how to successfully implement effective strategies to achieve the Cochrane’s Knowledge Translation’s operational objectives.
• Strong written and verbal communication skills.
• Willingness to work flexibly including outside normal working hours to accommodate different time-zones, and sporadic international travel.
• Commitment to Cochrane’s mission and principles

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with “External Communications and Multi-Media Officer” in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

For further information, please download the full job description.
Deadline for applications:  Friday 25th May 2018 (12 midnight GMT)

New evidence published today in the Cochrane Library shows that human papilloma virus (HPV) vaccines protect against cervical lesions in young women, particularly in those who are vaccinated between the ages of 15 and 26. It also summarizes findings on harms that have been assessed in randomized controlled trials. Below is a round-up for some of the media coverage. 

• "HPV vaccines prevent cervical cancer, global review confirms" on CNN
• "HPV jab safe and effective, studies finds" on BBC Health
• "Major review backs cervica cancer shots, especially for teens" on Business Insider
• "Does HPV vaccination prevent the development of cervical cancer?" on Medical Press
• "HPV vaccinations do not increase the risk of serious side effects, study finds" on PULSE
• "Review finds HPV vaccine highly successful against cancer" on Newstalk ZB
• "Review finds HPV vaccine safe, effective - expert reaction" on New Zeland Doctor Online
• "HPV vaccine for Schoolgirls gets full marks - is it nw time for boys to get it too?" on ITV News

Related

• Read the Press Release
• Read the Scientific community reaction
• Read the full Cochrane Review

New evidence published today in the Cochrane Library shows that human papilloma virus (HPV) vaccines protect against cervical lesions in young women, particularly in those who are vaccinated between the ages of 15 and 26. It also summarizes findings on harms that have been assessed in randomized controlled trials. Below is a collection of expert reactions to this new Cochrane Review.

Prof Keith Neal, Emeritus Professor of Epidemiology, University of Nottingham, said:
 
“This study looks at a collection of studies looking at the benefit of HPV vaccines in reducing pre cervical cancer lesions.  HPV also causes many other serious cancers (especially head and neck).  In time, as more people have been vaccinated, we will see a reduction in all HPV cancers.  The HPV vaccine is one of a number of vaccines using virus like particles (VLPS) which have been shown to be very safe over the last 35 years.
 
“The Cochrane library of reviews has a very rigorous assessment process of all their reviews.
 
“The review only looked at cervical precancer (in women and girls), and does not make any comments about whether boys should be given the vaccine too.  But it is an interesting question – the current argument from UK authorities is that herd immunity will protect boys as well.  But this is not completely true because 10% of girls do not get vaccinated, nor does it cover sexual activity when abroad or with arrivals to the UK after the vaccination age.  Gay men will never be covered by herd immunity from females, hence the separate programme for gay men to receive the vaccine at GUM clinics.  Boys can only be fully protected if all their sexual partners have been vaccinated fully.”

Dr Mary Ramsay, Head of Immunisations, PHE, said:
 
“This study adds to the wealth of growing evidence from around the world which shows that the HPV vaccine is the most effective way for young girls to protect themselves against cervical cancer.
 
“Most women aged 15 to 25 years in the UK have now received the HPV vaccine.  Public Health England has already shown that the HPV vaccine has contributed to a significant decrease in rates of infection with the two main cancer-causing HPV types(16 and 18) in vaccinated and unvaccinated women.  This is consistent with very high vaccine effectiveness and substantial herd protection.  In time, it is expected that the vaccine will save hundreds of lives every year.”
 
Prof Peter Openshaw, President of the British Society for Immunology, said:

“Today’s publication of the Cochrane Library review into the effectiveness and safety of the human papilloma virus (HPV) vaccine paints a reassuring picture, highlighting the huge public health benefits that this vaccine offers to young women.
 
“This very comprehensive review found that the HPV vaccine protects against pre-cancerous changes in the cervix, particularly when given to women aged 15–26.  It also finds that, so far, the vaccine causes no serious side-effects.  This is very important to emphasise: the negative press that the vaccine has received in some countries is completely unfounded on evidence.  The fact that we now have a vaccine that can safely reduce the likelihood of women developing cervical lesions (which often lead to cervical cancer) should be greeted with the highest level of enthusiasm.
 
“Although the HPV vaccine was originally introduced to prevent cervical cancer in women, it’s now recognised that human papilloma virus can cause a number of other diseases in both sexes (which aren’t included in this review) such as genital warts and some other cancers, including those of the anus and some types of mouth and throat cancer.  These cancers are rarer than cancer of the cervix, but are really important to prevent too.  While this review only concentrates on the effectiveness of the HPV vaccine in relation to cervical lesions, we need to remember that it may confer additional health benefits outside the scope of this review.
 
“Vaccines are among the most effective methods we have to prevent disease.  The introduction of the HPV vaccine in the UK in 2008 represented a major step forward in public health, protecting future generations from developing cervical cancer.
 
“The British Society for Immunology celebrates the huge health benefits that this vaccine delivers.  It is now crucial that we redouble efforts to ensure that HPV vaccination rates in girls remain high and that we continue to actively communicate the benefits of this vaccine to parents and children.”

Prof Margaret Stanley FMedSci, Emeritus Professor of Epithelial Biology and Research Visitor in the Department of Pathology, University of Cambridge, said:

“This intensive and rigorous Cochrane analysis of the published clinical trials undertaken with the commercially available HPV vaccines provides reassuring and solid evidence of the safety of these vaccines in young women, with no differences between vaccinated and unvaccinated girls and women in terms of reported serious side effects.  It reinforces the evidence that preventing infection by vaccination in young women, with the most important cancer causing HPVs 16 and 18, reduces cervical precancers dramatically.  These cervical precancers are the obligate precursors to the life threatening cancer; prevent the precancer and you prevent the cancer.  In every clinical trial reviewed in this study the vaccines prevented the development of almost all HPV16/18 caused precancers.  These clinical trial results are now being replicated in real life in countries with national HPV vaccination programmes such as the UK – dramatic reductions in the high grade precancers have been shown in Scotland in 20-25 year old women vaccinated at school when they were 12-15.”

Dr David Elliman, Consultant in Community Child Health, and RCPCH paediatrician (Royal College of Paediatrics and Child Health), said:

“An expert group under the umbrella of the respected Cochrane Collaboration has reviewed all the trials of HPV vaccines.  They looked at how well the vaccines worked and how safe they were.  After carefully examining all the data, and only including all that which was likely to be accurate and unbiased, they reviewed 26 trials covering 73,428 girls or women.  Data on boys and men were not included.

“They concluded that both the vaccines that have been in common use (the bivalent vaccine Cervarix and the quadrivalent vaccine Gardasil) were highly effective at preventing infection with the HPV viruses in the vaccines and to a lesser extent reduced infection with some other HPV strains.  They also found that the vaccines were highly effective at reducing the incidence of precancerous changes in the cervix, associated with the vaccine strains, that can lead on to cancer.  (Because it takes a long time after infection with the virus before cancer develops, there are no published data on this yet.)  Changes due to other strains were also reduced, but less so.  The main effects were seen in younger females, especially those who were known not to be already infected with HPV.

“The group also looked at the incidence of side effects, following the vaccines.  They found that, as expected, a number of people had local reactions but there were no serious side effects following the vaccine.”

Prof Helen Bedford, Professor of Children’s Health, UCL Great Ormond Street Institute of Child Health, said:

“HPV vaccine was introduced 10 years ago for 13-14 year old girls to prevent infection with human papillomavirus (HPV) which can lead to cancer of the cervix, a condition that claims the lives of over 800 women in the UK each year.

“This important review of high quality studies shows that HPV vaccines are effective in preventing changes in the cervix that can lead to cancer, particularly when given to young women.  It also provides reassuring evidence of the safety of HPV vaccines.

“This study provides solid evidence of the effectiveness of HPV vaccines.  This, together with early evidence of reduction in cervical cancer in Finland1, confirms the ground breaking value of this cancer preventing vaccine.”

1 Luostarinen T et al. ‘Vaccination protects against invasive HPV-associated cancers’. Int J Cancer, 2018; 142 (2186-2187)

• Read the press release
• Read the full Cochrane Review
• Read the round-up of media coverage

Declared interests

• Prof Keith Neal: "No conflicts."
  
• Prof Peter Openshaw: “Prof Peter Openshaw’s research is funded by the Wellcome Trust, the MRC, BBSRC and the European Union. He has received honoraria or consultancy fees from GSK, Janssen, and Mucosis BV.”
  
• Prof Margaret Stanley: “Professor Margaret Stanley has acted as consultant and advisor to Glaxo Smith Kline Biologicals and Merck.”
• Dr David Elliman: “No interests.” 
• Prof Helen Bedford: “I have no conflicts of interest.”
• No others received.

Full citation: Arbyn M, Xu L, Simoens C, Martin-Hirsch PPL. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD009069. DOI: 10.1002/14651858.CD009069.pub3.

New evidence published today in the Cochrane Library shows that human papilloma virus (HPV) vaccines protect against cervical lesions in young women, particularly in those who are vaccinated between the ages of 15 and 26. It also summarizes findings on harms that have been assessed in randomized controlled trials.

Most people who have sexual contact at some point in their life will be exposed to the human papilloma virus (HPV). In the majority of women, HPV infection will be cleared by the immune system. When the immune system does not clear the virus, persistent HPV infection can cause abnormal cervical cells. These lesions are known as cervical ‘precancer’ because over time they can progress to cervical cancer if left untreated.  

There are many different types of HPV. Some are associated with the development of cervical lesions that can become cancerous and are considered as high-risk HPV types. Two of these high-risk types (HPV16 and HPV18) account for about 70% all cases of cervical cancer worldwide. Vaccines have been developed that help the immune system to recognize certain HPV types. Because cervical cancer can take several years to develop, regulatory bodies and international health agencies such as the World Health Organization (WHO) regard cervical lesions as the preferred outcome measure for HPV vaccine trials.

A team of Cochrane researchers has summarized results of 26 studies in 73,428 women conducted across all continents over the last eight years. Most women in the studies were under the age of 26 years old, although three trials recruited women between 25 and 45 years. The studies were well-designed, randomizing the women to either HPV vaccine or a placebo. The review evaluates evidence for two vaccines: the bivalent vaccine targeting HPV16 and 18, and the quadrivalent vaccine targeting HPV16/18 and two low-risk HPV types causing genital warts. The newer vaccine that targets nine HPV types was not included in the review since it has not been compared against a placebo in a randomized controlled trial.

The review looked at two groups of people: women who are free of high-risk HPV at the time of vaccination and all women regardless of HPV status at vaccination. The effects of the vaccine were measured as precancer associated with HPV16/18 and precancer irrespective of HPV type. The review looked at data from ten trials assessing cervical lesion data at between three and a half to eight years after vaccination.

None of the studies have followed up participants for long enough to detect an effect on cervical cancer.  The researchers looked at precancer cervical lesions instead. They found that in young women who did not carry HPV, vaccination reduced the risk of developing precancer. About 164 per 10,000 women who got placebo and 2 per 10,000 women who got the vaccine went on to develop cervical precancer.   

The researchers also looked at data from all enrolled women regardless whether they were free of high-risk HPV at vaccination or not. Among women aged 15 to 26 years, vaccines reduced the risk of cervical precancer associated with HPV16/18 from 341 to 157 per 10,000.  HPV vaccination reduced also the risk for any precancer lesions from 559 to 391 per 10,000.

In older women vaccinated between 25 to 45 years the HPV vaccine does not work as well. This might be because older women are more likely to have been exposed already.

The evidence also shows that the vaccine does not appear to increase the risk of serious side effects which was about 7% in both HPV vaccinated or control groups. The researchers did not find increased risk of miscarriage in women who became pregnant after vaccination. However, they emphasize that more data are required to provide greater certainty about very rare side effects and the effect vaccines have on rates of stillbirth, and babies born with abnormalities in those who became pregnant around the time of vaccination.

Cochrane lead author, Dr. Marc Arbyn, from the Unit of Cancer Epidemiology, Belgian Cancer Centre, Sciensano, said: “The findings of this review should be viewed within the context of multiple global surveillance studies, which have been conducted by the Global Advisory Committee on Vaccine Safety from the WHO since the vaccinations were licensed. The committee concluded that the risk-benefit profile of prophylactic HPV vaccines remains favourable and expressed its concerns about unjustified claims of harm that lack biological and epidemiological evidence, and which may affect the confidence of the public. At the same time, the Committee encouraged health authorities to continue surveillance and examination for potential adverse events." 

Dr. Jo Morrison, Consultant in Gynaecological Oncology at the Musgrove Park Hospital, Somerset, UK, said: “Vaccination aims to prime the immune system to produce antibodies that can block subsequent natural HPV infection. These data show that immunizing against HPV infection protects against cervical precancer, and it is very likely that this will reduce cervical cancer rates in the future. However, it cannot prevent all cervical cancer and it is still important to have regular screening, even if you have been vaccinated.”

She added: “Cervical cancer can take many years to develop following HPV infection and development of precancer lesions, therefore long-term follow-up studies are needed to find out the effects of HPV vaccination on cervical cancer rates.

• Read the expert reaction
• Read the full Cochrane Review
• Read a round-up of the media coverage

Editor’s notes: 

Full citation: Arbyn M, Xu L, Simoens C, Martin-Hirsch PPL. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD009069. DOI: 10.1002/14651858.CD009069.pub3.

Breakdown of results by sub-groups of women:

Women who are hrHPV DNA negative (only efficacy data for women aged 16-26y)

HPV vaccines reduce hgCIN associated with HPV16/18 from 164/10,000 to 2/10,000 (high certainty). They reduce also any precancer irrespective of HPV types from 287/10,000 to 106/100,000 (high certainty). HPV vaccination protects also against AIS associated with HPV16/18 (from 9 to 0 per 10,000) and any AIS (from 10 to 0/10,000) - moderate certainty for both AIS outcomes.

 Women who are HPV16/18 DNA negative

The effect of HPV vaccines on risk of precancer differ by age group. In younger women, HPV vaccines reduce precancer associated with HPV16/18 from 113 to 6/10,000 (high certainty). HPV vaccines lower any precancer from 231 to 95/10,000 (high certainty). In females older than 25, the vaccines probably reduce precancer associated with HPV16/18 from 45 to 14/10,000 (moderate certainty).

Women unselected by HPV DNA status

In women vaccinated at 15 to 26 years of age, HPV vaccination reduces precancer associated with HPV16/18 from 341 to 157/10,000 (high certainty) and any precancer from 559 to 391/10,000 (high certainty).

In older women vaccinated between 25 to 45 years, the effects of HPV vaccine on precancer are smaller, and this may be due to previous exposure to HPV. The risk of precancer associated with HPV16/18 is probably lowered from 145/10,000 in unvaccinated women to 107/10,000 following HPV vaccination (moderate certainty). The risk of any precancer is probably similar between unvaccinated and vaccinated (341/10,000 compared with 356/10,000, moderate certainty).

For further information, please contact,

Jo Anthony
Head of Knowledge Translation, Cochrane
+44(0) 7582 726 634
janthony@cochrane.org or pressoffice@cochrane.org

Dr. Marc Arbyn
Epidemiologist
Unit of Cancer Epidemiology, Belgian Cancer Centre
Sciensano
Juliette Wytsmanstreet 14
B-1050 Brussels
Belgium
Marc.Arbyn@sciensano.be

Dr. Jo Morrison:
Consultant in Gynaecological Oncology
Department of Gynaecological Oncology
Musgrove Park Hospital
Taunton and Somerset NHS Foundation Trust, UK
jo.morrison@tst.nhs.uk

If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: pressoffice@cochrane.org

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How can you help?

First of all, sign up to Cochrane Crowd.

Then complete the short (10-15minutes) training module for the randomised controlled trial task (RCT ID).

And then head straight into live screening, where you’ll contribute to the tally and get us closer to 2 million!

Join the Crowd 2 million: Show us your screen campaign

Once you’ve signed up and done the training, please join us for Crowd 2 million: Show us your screen. It’s our way of connecting our community while we work to 2 million together.

Here’s how to get involved:

1. Head to the Crowd home page and take a screenshot clearly showing the classifications tally.  Go on, you can do it right now!

2. Post the image to Twitter with this message “Countdown to @crowd_cochrane 2 million! My screen shows [insert number, e.g. 1,935,781]. How about yours? Take a look: www.crowd.cochrane.org #Crowd2million #ShowUsYourScreen”

Here’s an example tweet:

Might as well log in to Twitter right now! ;)

3. Then, get screening, of course!

4. We encourage you to tweet as per numbers 1 & 2 above as often as you like in the lead up to 2 million, updating your screenshot each time.

Prizes will be given to the 10 people who get screenshots AT or as close as possible to 2 million!

To be eligible for a prize you’ll need to post two or more times within the #Crowd2million campaign. That is, at least once in the lead up, and once as close to the milestone as you can get!

When will we cross 2 million?

There really is no way to know when the 2 million mark will be crossed. It will be the thick of night for some of you. Loyal screeners have been known to set 2am alarms in an effort to be there for milestones (I’m thinking back to the countdown to 1 million). Now we don’t necessarily want to create a broken night’s sleep but we would love you to be there, if you would like to be!

See you at 2 million!

From Anna, Emily and the rest of the Cochrane Crowd team

Contact us at crowd@cochrane.org, and follow us on Twitter.

The College of Optometrists, UK has funded two Cochrane Review updates in support of the Cochrane Eyes and Vision (CEV) group based at the London School of Hygiene and Tropical Medicine (LSHTM). The global review updates were used to answer questions on the topics of Vision screening for correctable visual acuity deficits in school-age children and adolescents and Reading aids for adults with low vision.

The review updates produced the following key findings:

Vision screening

• There are no studies comparing vision screening with no vision screening highlighting a gap in evidence.
• Vision screening with the provision of free spectacles results in more children wearing spectacles after screening compared with giving the children a prescription on its own. Children in the free-spectacle group had better educational attainment, although this evidence was not as strong.
• Ready-made and custom-made spectacles appear to give similar visual results and similar spectacle wearing compliance levels.

Reading aids for adults

• There is insufficient evidence supporting the use of a specific type of electronic or optical device for the most common profiles of low-vision aid users. However, there is some evidence that stand-mounted electronic devices may improve reading speeds compared with optical devices.
• There is less evidence to support the use of head-mounted or portable electronic devices; however, the technology of electronic devices may have improved since the studies included in this review took place.
• There is no good evidence to support the use of filters or prism spectacles.

Priya Morjaria MCOptom, author of the vision screening review, said: “Over the past decade, it has become more apparent that as clinicians, we need evidence-based practice and practice-based evidence to make sure that we are not only doing what is best for our patients but also doing it in the best way possible. Findings from reviews help us understand this and ensure we continue to improve and do what is best based on evidence.

“This specific review highlights that screening children with a vision impairment and providing them with spectacles can increase their compliance with spectacles. This can in turn lead to better educational outcomes.” 

Jennifer Evans, Editor at CEV, said: “Cochrane Eyes and Vision would like to thank the College of Optometrists for supporting two important Cochrane Review updates. Uncorrected refractive error is an important cause of visual impairment in children. Approximately one per cent of children worldwide (13 million) are estimated to be visually impaired due to the eye disorder. The current update of the vision screening review enabled us to include emerging evidence that shows that vision screening with provision of free spectacles results in more children wearing spectacles and may lead to better educational attainment.

The second review demonstrates that it is important for people with low vision to find the right reading aid. Our review on reading aids for low vision provides a systematic assessment of the research in this area. The updated review provides evidence that electronic aids may help people with low vision with improved reading speeds and reading duration, compared with using optical aids. The review highlights lack of evidence for use of filters or prism spectacles for people with age-related macular degeneration.”

• Visit the Cochrane Eyes and Vision website
• Read the full College of Optometrists Press Release

The 7th national congress of Croatian Society of Physical and Rehabilitation Medicine (PRM), Croatian Medical Association (CSPRM) was been held in Šibenik, Croatia, 19-22 April 2018. Two round tables - about Quality management in PRM and Cochrane Rehabilitation initiative were held.

During the meeting a Memorandum of Understanding between Cochrane Rehabilitation and the CSPRM was been signed. This will ensure a collaboration between the two Organizations in projects of mutual interest, supporting the development of PRM worldwide and aiming to optimize the treatment of patients with disability.

Congratulations on this new partnership!

• Visit the Cochrane Rehabilitation website

Today Cochrane announces important decisions on its future publishing and open access arrangements, part of its commitment of making Cochrane evidence freely and openly accessible to everyone all over the world.

Cochrane has agreed improved terms and a two-year extension of its existing publishing agreement with John Wiley & Sons, Limited, which means Wiley will continue to publish the Cochrane Library until 31st December 2020. In June 2018 the enhanced Cochrane Library will be launched on a new publishing platform (built by the specialist third party HighWire), allowing many new features to be developed and launched over the next two years that will offer increasing value for Cochrane Library subscribers.

Cochrane will also open and run a competitive tender process in 2019 to establish who will publish the Cochrane Library from 1st January 2021. Future publishers will be required to show how they plan to partner with Cochrane to develop the Library so that it becomes the ‘Home of Evidence’ at the heart of health decision making around the world; whilst also maintaining and expanding Cochrane Library revenues. Royalties from sales of the Cochrane Library are the major source of funds for the charity – over £6 million in 2017 – despite 3.66 billion people around the world having one-click access to the Library either through highly-subsidised national licences (for 1.5 billion) or free provision for populations in low- and middle-income countries eligible under the WHO’s HINARI initiative (2.1 billion).

This is part of Cochrane’s extensive commitment in its Strategy to 2020 that aims to put Cochrane evidence at the heart of health decision-making all over the world.

Since February 2013, when the current contract with Wiley was signed, Cochrane is proud to have:

• Provided free access to new and updated Cochrane Reviews for all readers worldwide 12 months after publication, under our ‘green’ Open Access scheme. Over half of all Cochrane Reviews are now available this way.
• Deposited all Cochrane Reviews in PubMed Central for open access publication 12 months after publication (started September 2016).
• Made all Cochrane Review protocols freely available on publication (since February 2016).
• Provided Cochrane author teams with the option to pay an Article Publication Charge in order to make their new and updated reviews freely available worldwide on publication, and to take up other benefits of a Creative Commons licence, via a ‘gold’ Open Access option.

Cochrane’s Governing Board has decided to continue these policies under the post-2020 publishing arrangements, but to postpone implementation of the target set out in Strategy to 2020 to make all Cochrane Reviews open access ‘immediately upon publication’. This remains Cochrane’s long-term ambition, but it will be implemented only when the Governing Board are confident that it will not undermine Cochrane’s future sustainability and, therefore, its ability to meet other strategic goals. 

Cochrane’s Governing Board Co-Chair, Martin Burton said: “Extending our already very successful partnership with Wiley until the end of Strategy to 2020 will give us the time to develop exciting new products and features in the Cochrane Library, focus on the transformative organizational changes we need to deliver in the next two years, provide us with a stable and more predictable financial base, whilst also allowing us adequate time to choose our future publishing partners.” Cochrane’s Chief Executive Officer, Mark Wilson added: “We’re enormously proud of the Open Access offering that we’ve established over the last five years, which will make an ever-larger proportion of Cochrane Reviews universally accessible in the future. We plan to review our Open Access policy regularly after 2020 with our publishing partners to ensure we balance Cochrane’s financial viability with our long-term goal of providing immediate free access to Cochrane Reviews for the whole world.”

For more information on access options to the Cochrane Library, please visit cochranelibrary.com.

Looking for an innovative tool to teach evidence production? Cochrane Classmate might well be the answer!

Classmate is a trainers’ toolkit that allows you to create exciting, interactive tasks that help your students learn about evidence production. It is easy to use, and its first release is now available free of charge to anyone interested.

Register for our webinar to learn about Classmate and the benefits of using this new online learning environment. The webinar is on Thursday 17th May, 12.30-1.30pm BST.

Who is Classmate for? Anyone who teaches on topics related to evidence production, such as evidence-based medicine, systematic review production, understanding PICO, study designs, citation screening or research reporting standards. Classmate can be used in a variety of contexts such as university courses, workshops or other events.

What will be covered in the webinar? You’ll be taken on a tour of Classmate, including how to create a learning activity, invite students to the activity and monitor their progress. You’ll see the modules currently available on Classmate and hear about others launching soon.

• Can’t make the webinar? We will tweet the recording once it’s available, so follow us at @cochrane_crowd.
• Visit the Cochrane Crowd website

Support for Project Transform was provided by Cochrane and the National Health and Medical Research Counc12/12/1996il 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.

Specifications: Part Time 30 hours per week
Salary: Competitive
Location: London
Application Closing Date: Friday 4th May 2018

This role is an exciting opportunity to use your experience as a Finance Officer to make a difference in the field of health care research. 

The Finance Officer will maintain the sales and purchase ledgers for Cochrane, Collaboration Trading and Cochrane Innovations, including processing expenses for CET members, facilitating payments and reconciling bank statements.

We are looking for a self-motivated and highly organised individual who is able to work effectively and collaboratively with a diverse range of contacts across the world.  The successful candidate will also have:

• Demonstrable experience in all aspects of purchase ledger
• Experience of using Xero
• Intermediate Microsoft Excel skills
• Excellent communication skills with the ability to build relationships across the business
• Have the proven ability to work both independently and as part of a team
• Ability to work to tight deadlines
• Can demonstrate problem solving skills and a practical approach to dealing with day-to-day issues
• Proven experience of building productive working relationships, both internally and externally
• Ability to communicate clearly with non-finance employees about financial matters
• Commitment to Cochrane’s mission and values

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

If you would like to apply for this position, please send a CV along with a supporting statement to recruitment@cochrane.org with “Finance Officer” in the subject line.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples.  List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.

For further information, please download the full job description.
Deadline for applications: Friday 4th May 2018(12 midnight GMT)
Interviews to be held on: Monday 14th May 2018

Thiazides best first choice for hypertension

High blood pressure or hypertension can increase the risk of heart attacks and stroke. One of the most important decisions in treating people with elevated blood pressure is what drug class to use first. This decision has important consequences in terms of health outcomes and cost.

The Cochrane Hypertension Group, which is part of Cochrane Circulation and Breathing, updated their original 2009 Cochrane Review looking at what drug class was the best first-line choice in treating adult patients with raised blood pressure. No new trials were found in the update; keeping the total at 24 studies, that randomly assigned 58,040 adult people (mean age 62 years) with high blood pressure, to four different drug classes or placebo. Duration of these studies ranged from three to five years. Drug classes studied included thiazide diuretics, beta-blockers, ACE inhibitors, and calcium channel blockers.

The Cochrane Review concluded that most of the evidence demonstrated that first-line low-dose thiazides reduced mortality, stroke, and heart attack. No other drug class improved health outcomes better than low-dose thiazides. Beta-blockers and high-dose thiazides were inferior. High-quality evidence supported that low-dose thiazides should be used first for most patients with elevated blood pressure. Fortunately, thiazides are also very inexpensive.

“The decision as to which drug to use first-line for the management of hypertension is an important one for clinicians" says James Wright the first author of this updated Cochrane Review.  “Knowing that the evidence for first-line thiazides is better than other classes of drugs is great news for clinicians as thiazides are also the least expensive and have other advantages.  Both clinicians and patients can be reassured that Cochrane evidence, recognized as the gold standard of health evidence, supports this.”

• Read the Plain Language Summary
• Read the Full Review
• Visit the Cochrane Hypertension website
• Visit the Cochrane Circulation and Breathing website

The March for Science is a celebration of passion for science and the many ways science serves our global communities.

Cochrane officially supports and is in partnership with the March for Science. The March is organized in Washington, DC, with satellite marches in cities around the world, to champion the science that upholds the common good.

For the second year, the Cochrane contibuters and supporters around the globe marched for science! Will you march with us in 2019?

On Monday 16th April Cochrane published the first Cochrane-wide peer review policy.  In addition to standardising current practice across all of Cochrane’s 53 Review Groups, the introduction of the new policy aims to improve transparency in communication and decision making, consistent with core Cochrane principles, and taking the opportunity to implement current best practice.

The key highlights of the new policy include:

• From January 2019 Cochrane will adopt a named peer review policy, whereby authors and peer reviewers know each other’s identities during the peer review process.
• A decision workflow for deciding when to peer review updated protocols and updated Cochrane Reviews.
• A minimum number and type of peer reviewer.
• A minimum standard for acknowledgement of peer reviewer contributions.

As the policy will require some Cochrane Review Groups to change the current practice significantly, the policy will be implemented between now and January 2019, with the aim that each Cochrane Review Group will be compliant with the new policy by January 2019.

If you have any comments of questions about the peer review policy, please contact Bryony Urquhart, Editorial and Methods Department.

David Tovey
Editor in Chief