Lund University in Sweden is using Cochrane training materials and tools to help medical students better understand and interpret health evidence.

Lund has an institutional subscription offering all staff and students access to Cochrane Interactive Learning and RevMan. Cochrane Interactive Learning was developed by world-leading experts and provides 12 modules of self-directed learning on conducting a complete systematic review process for both new and experienced review authors. RevMan simplifies creating systematic reviews and meta-analyses and presenting the results in forest plots. Lund has successfully embedded these resources into their medical education curriculum since 2018. 

In 2017, the university’s medical degree program team reviewed their curriculum with a view to enhancing the scientific scholarship elements of the course. Working closely with Cochrane Sweden and the faculty library, they developed a curriculum that embeds Cochrane Interactive Learning modules and practical tools to help future doctors better engage with and contribute to scientific literature. 

The initiative was spearheaded by Maria Björklund, Librarian in Lund University’s Faculty of Medicine, who collaborated with colleagues across the university to make the Cochrane-informed curriculum a reality. The team have now described and published their approach in BMJ Evidence Based Medicine to help other medical schools who may wish to follow suit. 

“Incorporating Cochrane training materials in the curriculum has proven to be a success,” says Maria. “Student feedback has been positive, and some have been inspired to co-author their own systematic reviews or go into clinical research. It’s been a collaborative effort from the start and has been incredibly rewarding for everyone involved. The Cochrane modules perfectly complement our refreshed curriculum, supported by passionate tutors and doctors practicing evidence-based medicine sharing their real-world experience of how to apply the principles in practice.” 

The curriculum embeds Cochrane Interactive Learning, which offers online interactive courses to any university or individual with a subscription. These provide a thorough grounding in systematic review and evidence evaluation, supported by in-person workshops and assignments throughout the Lund University course. 

The close collaboration between faculty staff at Lund and Cochrane Sweden means that students who are inspired to take their interest further have excellent opportunities to do so. Matteo Bruschettini, Director of Cochrane Sweden, helps to mentor and support students who want to co-author their own Cochrane reviews in their areas of interest. 

“Thanks to the Cochrane training materials in the curriculum, many students are inspired and empowered to conduct systematic reviews,” says Matteo. “Through Cochrane Sweden, we help them to design and take forward new Cochrane reviews. This is really a win-win, as we know that the students have an excellent grounding in the relevant methods and we can help them put it into practice and contribute to health evidence themselves. Collaboration is key to the success of this project, and Lund is very lucky to have Maria and her team to drive this forward.” 

Cochrane resources are currently embedded in Lund’s medical doctor training course, and are being rolled out in other subjects including public health, psychology and medical science. This has been driven by word of mouth due to the popularity of the modules among staff and students.

“It’s inspiring to see how Lund University has used Cochrane resources to enhance their medical training and ensure that the doctors of the future are well-equipped to navigate the complex evidence landscape,” says Catherine Spencer, Chief Executive of Cochrane. “I would love to see more medical schools around the world following their example, and we would be happy to speak to anyone who is interested in taking this forward." 

• Learn more about Cochrane Interactive Learning|
• Learn more about RevMan

At the Cochrane Collaboration, open science has long been at the heart of our ethos. From publishing free plain language summaries in multiple languages to making study data available, we have always strived to make our evidence accessible, transparent and useful to as many people as possible.

Since 2013, we’ve made all Cochrane reviews freely available 12 months after publication and all protocols freely available immediately. Over 3 billion people worldwide have immediate access to all content through national access agreements and our free access offering to over 100 low- and middle-income countries.

We’d like to go further to ensure that everyone can benefit from access to Cochrane evidence. However, in this challenging funding environment, we still need income to keep producing and publishing the reviews that are trusted by researchers, clinicians and policymakers worldwide.

We have to balance our open access ambitions with our responsibility to run the charity sustainably. A model that made our content free, but deprived us of the income to produce or publish it in the first place, would be of little benefit to anyone. Our original ambition was to make all Cochrane reviews open by 2025 if we could identify a financially sustainable path to get there, without putting the onus on authors. However, it became clear that this would not be possible in that timescale. While full open access remains our ambition, we have to be realistic about how long this will take and are exploring ways to broaden access to our content in the meantime.

Our independence is one of our core founding principles; we do not accept donations or sponsorship from conflicted sources, such as pharmaceutical or medical device companies. That makes us unusual among medical and scientific charities, many of which rely on corporate benefactors to pay the bills. Not Cochrane. As a charity that publishes impartial assessments of many medical interventions and diagnostics produced and promoted by corporations, we have a strong conflict of interest policy to protect our content from undue influence.

We want our reviews to be accessible to as many people as possible, but we won’t compromise our principles or quality. The complexity of producing, editing and publishing systematic reviews makes Cochrane a poor fit for the current ‘gold’ open access model, where authors pay a fee to cover publishing costs. Conducting and publishing systematic reviews is neither cheap nor easy, and this vital work needs to be funded.

As we can’t make everything open access immediately, we are working with our publisher, Wiley, to broaden global access to Cochrane content while ensuring we can still produce it.

We are working together to significantly expand free public access worldwide. Fourteen countries currently have national provisions whereby government agencies sponsor free public access for everyone in the country. Visitors from those countries do not encounter paywalls and can access Cochrane Library content without logging in. Building on this, we aim to unlock content for large regions when a critical mass of countries within the region subscribe to the Cochrane Library via national provisions. We will work towards this goal collaboratively with Cochrane groups across the world, national funding agencies and Wiley.

We intend to make all review protocols open access from 2025 onwards with a CC-BY license and are exploring open access for other outputs such as editorials and plain language summaries. We will continue to invest in our open access journal, Cochrane Evidence Synthesis and Methods, helping the global evidence synthesis community to keep up with the latest methodological developments. We may also add other open access journals to our core database of products in the future.

We are still working out the details of our long-term transition to open access, but we are confident that we will arrive at a sustainable solution that balances the needs of authors, readers and subscribers. The Cochrane Collaboration was founded 30 years ago to fill a crucial evidence gap, and we need to preserve our income and integrity to ensure we can continue to fulfil our mission in the decades to come. We hope that you will support us on this journey as we strive to produce the best health evidence and make it accessible to everyone, everywhere.

Specifications: Permanent – Full Time (1.0 FTE.)
Salary:   circa £35,000 per Annum
Location: (Remote – Flexible) Ideally based in the UK, Germany or Denmark. Candidates anywhere from the world will be considered; however, Cochrane’s Central Executive Team is only able to offer consultancy contracts outside these countries for 1-Year.
Closing date: 21 April 2024

Cochrane is an international charity. For 30 years we have responded to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesising research findings and our work has been recognised as the international gold standard for high quality, trusted information.

Cochrane's strength is in its collaborative, global community. We have 110,000+ members and supporters around the world. Though we are spread out across the globe, our shared passion for health evidence unites us. Our Central Executive Team supports this work and is divided into four directorates: Evidence Production and Methods, Publishing and Technology, Development, and Finance and Corporate Services.

To help maintain and evolve Cochrane’s cloud hosting and application deployment infrastructure, ensure applications’ dependencies are kept current (both independently and in collaboration with development teams), and promote operational awareness across the infrastructure. This role works across development and operations (DevOps).

Don’t have every single qualification? We know that some people are less likely to apply for a job unless they are a perfect match. At Cochrane, we’re not looking for “perfect matches.” We’re looking to welcome people to our diverse, inclusive, and passionate workplace. So, if you’re excited about this role but don’t have every single qualification, we encourage you to apply anyway. Whether it’s this role or another one, you may be just the right candidate.

Our organization is built on four core values: Collaboration: Underpins everything we do, locally and globally. Relevant: The right evidence at the right time in the right format. Integrity: Independent and transparent. Quality: Reviewing and improving what we do, maintaining rigour and trust.

You can expect:

• An opportunity to truly impact health globally.
• A flexible work environment
• A comprehensive onboarding experiences.
• An environment where people feel welcome, heard, and included, regardless of their differences.

Cochrane welcomes applications from a wide range of perspectives, experiences, locations, and backgrounds; diversity, equity and inclusion are key to our values.

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Door-to-door tuberculosis (TB) screening and contact tracing can improve diagnosis rates, but must be paired with effective follow-up care to be successful, a new Cochrane review has found.

Active case finding (ACF) seeks to improve diagnosis rates in people living in communities who may not otherwise present to health facilities, helping them access treatment and reduce onward transmission.

Despite being a key strategy of most TB strategies globally, there is often little consideration of how these programmes are experienced by communities. This is essential in designing appropriate and effective services.

Published ahead of World TB Day (24 March), a new review published by Cochrane Infectious Diseases, based at Liverpool School of Tropical Medicine, looked at studies of community experiences towards ACF programmes for TB in any endemic low- or middle-income country. This was a qualitative evidence synthesis that looked at the evidence from 45 studies. 

Senior author and Cochrane Infectious Diseases Editor, Professor Sandy Oliver,  said, “The power of qualitative syntheses like these is in their ability to capture rich information from various contexts to develop a deep understanding of how policies play out in the real world – how services deliver them, how communities receive them or avoid them, what might make them work a little better, and why”.

The review authors found that ACF improves access to diagnosis for many, but does little for those in financial need to continue care. People may also experience stigma in relation to screening.

It was also shown that ACF can create expectations for follow-up care that health systems may not be able to meet, as well as health workers finding it difficult to implement.

This Cochrane Review will help to better understand policy in action and the perceived benefit relative to the harm of ACF.

Lead author Melissa Taylor said: “Active case finding brings diagnosis to many of those who may otherwise not have received it. However, our review demonstrates it is essential that active case finding is linked to well-resourced follow up services and wider health system strengthening.”

• Read the full Cochrane review and plain language summary
• Learn more about this review on the Cochrane Infectious Diseases website

Taylor M, Medley N, van Wyk SS, Oliver S. Community views on active case finding for tuberculosis in low‐ and middle‐income countries: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD014756. DOI: 10.1002/14651858.CD014756.pub2

In this blog for colorectal surgeons and health professionals involved in stoma reversals, Dr Stina Öberg, Dr Siv Fonnes, and Professor Jacob Rosenberg from the Cochrane Colorectal Group discuss new practice-changing Cochrane evidence, showing that a simple change of suture technique likely results in a large reduction in surgical site infections in people undergoing stoma reversal.

Take-home points

• The stoma closure site can be considered a clean-contaminated wound, and many patients develop a surgical site infection after having a temporary ileostomy or colostomy reversed.
• Surgeons often use linear skin closure after stoma reversal. In theory, a clean-contaminated wound can benefit from drainage, which is achieved by using the purse-string skin closure technique.
• A new Cochrane Review has demonstrated that the purse-string skin closure technique likely results in a large reduction in surgical site infections after stoma reversal compared with linear skin closure.
• This simple and inexpensive change of practice may also improve patient satisfaction slightly. Even though the evidence is very uncertain, there seems to be no difference in incisional hernias.

Can surgeons improve their skin closure technique after stoma reversal? Yes - in a straightforward way! Researchers have found clinically important evidence in a new Cochrane review, showing that a simple change of suture technique likely results in a large reduction of surgical site infections in people undergoing stoma reversal. This blog presents the key results from this Cochrane review.

Skin closure after stoma reversal
Temporary stomas are created to protect distal bowel segments. At the time of stoma reversal, the last step is to close the skin. Due to the proximity to intestinal content, the stoma closure site should be considered a clean-contaminated wound. This could also explain why surgical site infections are common after stoma reversal, occurring in up to 40% of patients. When a wound is potentially contaminated, it will in theory benefit from free drainage.

Linear skin closure
Most surgeons use linear (transverse) skin closure despite the possible contamination of the wound at the stoma reversal site. Linear skin closure provides poor or no wound drainage and is theoretically a poor choice for a clean-contaminated wound. The stoma reversal wound is often close to a circular shape, and there is an alternative skin closure technique that at the same time provides drainage - the purse-string technique.

Purse-string skin closure
The purse-string skin closure technique can be used for circular or ellipse-formed wounds. The technique is performed by using intradermal sutures that are drawn together like an old-fashioned drawstring purse (see illustration at the top of the page), leaving a small opening in the centre. The theoretical advantage of using purse-string skin closure for a clean-contaminated wound is that it provides free drainage. This advantage could lower the risk of developing surgical site infections compared with linear skin closure. A lower surgical site infection risk could also result in a better cosmetic result, a higher patient satisfaction, and fewer incisional hernias.

What are the benefits of the purse-string skin closure?
In the Cochrane review comparing purse-string skin closure versus linear skin closure in people undergoing stoma reversal, surgical site infection was assessed in nine randomised controlled trials including almost 800 patients. The purse-string technique likely results in a large reduction in surgical site infections compared with linear skin closure. The anticipated risk within 30 days after linear closure was 243 surgical site infections per 1000 patients versus 52 (95% confidence interval 28 to 85) per 1000 patients after purse-string skin closure.

Purse-string closure may also have other advantages over linear closure. Patients who received the purse-string skin closure seemed to be slightly more satisfied six and twelve months after surgery: the anticipated effect in two randomised controlled trials was 885 satisfied or very satisfied patients per 1000 patients having linear skin closure versus 994 (95% confidence interval 894 to 1000) per 1000 patients having purse-string skin closure.

Finally, a reduced risk of surgical site infections could reduce the risk of incisional hernias. This outcome was reported by four randomised controlled trials with nearly 300 patients followed between three and twelve months, showing an anticipated risk of 55 incisional hernias per 1000 patients after linear skin closure versus 29 (95% confidence interval 4 to 177) per 1000 patients having purse-string skin closure. Even though the purse-string skin closure theoretically could lower the risk of incisional hernias, this was not shown, and there seems to be little to no difference in the risk of developing incisional hernias regardless of the skin closure technique used. However, the evidence is very uncertain, and further randomised controlled trials with longer follow-up might alter this result.

What are the benefits of linear skin closure?
The Cochrane review showed no advantage of using linear skin closure compared with purse-string skin closure in patients undergoing stoma reversal.

What are the risks of the purse-string skin closure?
The Cochrane review suggested that there was no evidence of an increased risk when patients received the purse-string technique compared with linear skin closure.

Pros and cons of purse-string versus linear skin closure
To summarise:

The benefits of using purse-string skin closure:

• likely results in a large reduction in surgical site infections
• may improve patient satisfaction slightly

The benefits of using linear skin closure:

• none found

There seems to be no evidence of a difference between purse-string and linear skin closure regarding:

• incisional hernia (but the evidence is very uncertain)
• operative time (but the evidence is very uncertain)
• length of hospital stay (but the certainty of evidence is unknown)
• anastomotic leak (but the certainty of evidence is unknown)
• intestinal obstruction (but the certainty of evidence is unknown)

Which skin closure technique is best to use after stoma reversal?
Purse-string skin closure both has the theory and the evidence to back up a lower risk of surgical site infections compared with linear skin closure, seemingly without any risks of complications. The result from this Cochrane review could make surgeons reconsider their skin closure method in patients undergoing stoma reversal. A change of practice from linear to purse-string skin closure is both straightforward and inexpensive.

Clinical reflections on the implications of the review
When asking Professor Jacob Rosenberg, the co-ordinating editor of the Cochrane Colorectal Group, about the clinical implications of this Cochrane Review, he stated that:

• This review clearly shows that a simple change in skin closure technique can have a large impact on patient outcome after stoma reversal.
• The purse-string skin closure technique for the stoma site is simple, effective, and seemingly without negative effects.
• These results have the potential to change clinical practice around the world.
• The recommendation to use the purse-string method for skin closure of stoma sites should be included in future clinical guidelines.

Read the full Cochrane Review and plain language summary in the Cochrane Library 

Listen to the lead author, Shahab Hajibandeh from Health Education and Improvement Wales, to tell us more about this review in three minutes

Hajibandeh S, Hajibandeh S, Maw A. Purse‐string skin closure versus linear skin closure in people undergoing stoma reversal. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD014763. DOI: 10.1002/14651858.CD014763.pub2. 

Image: The featured image at the top of the page was created by Malene Agnete Højland and Louise Rosengaard from the Cochrane Colorectal Group.

Cochrane marks the second anniversary of the commitment to Public Involvement in Health and Social Care Research, a pledge launched in March 2022. This commitment underscores Cochrane's ongoing efforts to enhance its practice of public involvement in health and social care research.

Cochrane is one of twenty-one organizations signed up to the pledge, including the UK’s National Institute for Health and Care Research (NIHR) and the Health Research Authority (HRA).

Richard Morley, Cochrane's Consumer Engagement Officer, reflects on this initiative: “Making a public commitment to involving the users of our evidence sets out our serious intent to build on our past achievements and deepen and broaden our work.”

A notable achievement is the establishment of the Co-Production Methods Group, launched in October 2023. Aligned with the ‘Putting People First’ commitment, this group will spearhead methods research, share resources for best practice, and supports learning and dissemination activities to help systematic review authors engage with and respond to the needs of consumers. 

To help people make sense of health evidence, Cochrane provides a free Evidence Essentials learning module. This free online resource offers an introduction to health evidence and how to use it to make informed health choices. The module has been co-produced by healthcare consumers, researchers and Cochrane's specialists, with contributions from a range of experts in their fields.

The Learning Live series builds on this, offering free webinars aimed at a range of audiences. Some webinars are aimed at Cochrane review authors, to help them make their research more widely accessible and understood. Others are aimed at helping people to engage with Cochrane research, such as webinars for teachers on using Cochrane Crowd in school projects. 

Looking ahead, Cochrane has a framework for consumer engagement and involvement that runs until 2027. This comprehensive approach revolves around five key elements. It emphasizes proactive engagement strategies, including communication, evidence dissemination, recruitment, and learning. Cochrane aims to elevate co-production by intensifying consumer involvement in the evidence production process, aligning reviews with user needs, and supporting consumer governance.

Prioritizing accessibility, the framework strives to enhance health literacy among healthcare consumers while making Cochrane's evidence more easily accessible. Strategic partnerships, particularly with patient groups, aim to enhance engagement, co-production, advocacy, and health literacy activities.

Finally, the framework incorporates an observatory to ensure evidence-based practices, monitor, and evaluate the impact of Cochrane's ongoing efforts in engagement and involvement.

• Learn more about Cochrane’s commitment to healthcare consumers
• Join Cochrane’s work as a patient, carer, or member of the public
• Email the Cochrane Consumers Network at consumers@cochrane.org 

Specifications: Permanent – Full Time
Salary:  £55,000 - £57,000 per Annum  
Location: Remote - Ideally based in the UK, Germany or Denmark. Candidates from the rest of the world will be considered; however, Cochrane’s Central Executive Team is only able to offer consultancy contracts outside these countries.
Closing date: 24 March 2024

Cochrane is an international charity. For 30 years we have responded to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesising research findings and our work has been recognised as the international gold standard for high quality, trusted information.

Cochrane's strength is in its collaborative, global community. We have 110,000+ members and supporters around the world. Though we are spread out across the globe, our shared passion for health evidence unites us. Our Central Executive Team supports this work and is divided into four directorates: Evidence Production and Methods, Publishing and Technology, Development, and Finance and Corporate Services.

The Executive Editor will be expected to prioritise and delegate editorial tasks as appropriate. The role holder will need to be an advocate for the Editorial Service internally and externally to Cochrane and remain alert to immediate demands of delivering high-quality review content for publication in a timely fashion.        

Don’t have every single qualification? We know that some people are less likely to apply for a job unless they are a perfect match. At Cochrane, we’re not looking for “perfect matches.” We’re looking to welcome people to our diverse, inclusive, and passionate workplace. So, if you’re excited about this role but don’t have every single qualification, we encourage you to apply anyway. Whether it’s this role or another one, you may be just the right candidate.

Our organization is built on four core values: Collaboration: Underpins everything we do, locally and globally. Relevant: The right evidence at the right time in the right format. Integrity: Independent and transparent. Quality: Reviewing and improving what we do, maintaining rigour and trust.  

You can expect:  

• An opportunity to truly impact health globally  
• A flexible work environment  
• A comprehensive onboarding experiences
• An environment where people feel welcome, heard, and included, regardless of their differences

Cochrane welcomes applications from a wide range of perspectives, experiences, locations and backgrounds; diversity, equity and inclusion are key to our values.

How to apply

• For further information on the role and how to apply, please click here
• The deadline to receive your application is 24th March 2024
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.  Read our Recruitment Privacy Statement