A Mission to Advance Evidence-Based Decision Making in Health Care

Much of the evidence used to formulate medical decisions is generated by vested interests. Pharmaceutical companies test medicines that they hope to sell for a profit. Medical device makers do the same for their own products. Clinicians, caregivers, and policymakers around the world use this evidence to treat patients and address health concerns.

One global organization is on a mission to promote evidence-based decision-making in health care that is independent of commercial interests. Cochrane is a network of universities and organizations that trains systematic reviewers in an effort to create a world in which every health decision is based on the best available evidence.

Founded in 1993 as a not-for-profit organization, Cochrane has amassed over 50,000 members in more than 130 countries. The Tufts University Cochrane Affiliate is one of only 23 institutions in the U.S. that are part of the global Cochrane network. Tufts joined in 2021 and focuses on public health in urban areas, including nutrition, maternal health, public health, and health equity.

Today, there are over 7,500 Cochrane systematic reviewers collaborating to produce accessible health information without conflicts of interest. Cochrane reviews are seen as the international gold standard for trusted, evidence-based health care information. Roughly 80% of World Health Organization (WHO) guidelines are based on Cochrane systematic reviews.

A systematic review aims to compile all published and unpublished scientific evidence about a specific, globally applicable topic and collate the information into one cohesive answer for use by medical practitioners and the public.

The systematic review process starts with a question, for instance: “What is the impact of cognitive rehabilitation on people with mild-to-moderate dementia?” or “How do mobile phone-based treatments affect contraceptive use among women?”

From there, the systematic review process follows a specific and lengthy protocol. Reviewers set specific parameters and review everything written about that topic, including clinical trials, that can be found primarily on digital publication sources. Reviewers analyze the methods, participants, funding sources, and outcomes. The goal is to produce one answer from the existing literature, establishing a high level of credibility in the process.

The Tufts Affiliate is led by Shayesteh Jahanfar, professor in the Department of Public Health and Community Medicine at Tufts University School of Medicine, in collaboration with the Tufts Clinical and Translational Science Institute and the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center. It is also involved with the U.S. Satellite of the Cochrane Pregnancy and Childbirth Group, which was co-established by Jahanfar who has been involved with Cochrane since 2002 as an author of systematic reviews and as a trainer, reviewer, and content expert in the field of maternal and child health. She also sits on the governing board of Cochrane’s newly established Maternal Newborn Child Health group.

“Our first goal is to conduct webinar training twice per year targeted toward clinicians, students, and faculty, to learn about systematic reviews. Participants are taught ​​how to develop research protocols, what a systematic review is, step-by-step methodology, and hands-on software,” Jahanfar says. “The second goal is knowledge translation, where we compile evidence-based reviews produced by Cochrane and re-format and publish it as Cochrane Corners in various journals. Then third, of course, is that we conduct systematic reviews.”

“The Cochrane Fellowship has completely transformed my career perspective. Initially, I was unfamiliar with systematic reviews, but now that I understand them, this is what I’m passionate about and where I want to focus my efforts.”

Isha Taneja, MG21 (MPH), the first Cochrane Fellow at Tufts

Real World Applications

The Tufts Cochrane Affiliate also hosts one Fellow every year. Isha Taneja, MG21 (MPH), was the group’s first Cochrane Fellow in 2021 while she was still pursuing her master’s with a concentration in epidemiology and biostatistics at Tufts School of Medicine.

Originally from India, Taneja graduated with a Bachelor of Medicine, Bachelor of Surgery (MBBS) from Rajasthan University of Health Sciences. She started her career as a physician in her home country where she organized counseling sessions for pregnant women to emphasize the importance of preventing prenatal and postnatal complications through diet and lifestyle changes.

She then moved to Michigan to take a position as a clinical research assistant at Detroit Medical Center before moving on to Massachusetts General Hospital in the Division of Allergy and Immunology. There, she focused on addressing the knowledge gaps of pediatricians regarding early introduction of peanuts to children.

Throughout her varied experiences in the health care system, both in the U.S. and in India, Taneja steadily found herself drawn to research. During her Master of Public Health program at the School of Medicine, Taneja joined a Cochrane systematic review author training, a three-week webinar in which participants dedicate three consecutive Fridays learning everything there is to know about systematic review. She quickly took to the process.

As the first Tufts Cochrane Fellow, Taneja contributed to two large reviews, one with fellow Cochrane authors and the other for the WHO. For both projects, the teams each produced extensive lists of thousands of articles that Taneja helped review. Every article, one by one, underwent an initial title and abstract review followed by a full text review. Taneja and a team of 18 MPH students acted as reviewers and conducted a quality assessment and risk of bias assessment for each study.

The review with fellow Cochrane authors looked at all the evidence on the ways in which a specific intervention impacted domestic violence against pregnant women. They found that the intervention (clinical nurse visitations of pregnant women in their homes to offer counseling) was successful at reducing domestic violence, as measured by infant birth weight.

For the WHO, Taneja helped conduct a review on global alignment with WHO surgical guidelines regarding implementation of the WHO surgical safety checklist during Cesarean sections. The paper and its results are forthcoming.

Taneja is now pursuing her Ph.D. at the City University of New York (CUNY) and still facilitates Cochrane systematic review training sessions like the one that initially sparked her interest many years ago.

“I’m planning to conduct a systematic review for my dissertation,” Taneja says. “The Cochrane Fellowship has completely transformed my career perspective. Initially, I was unfamiliar with systematic reviews, but now that I understand them, I know this is what I’m passionate about and where I want to focus my efforts.”

Michael Johannesmeyer, MG24 (MPH), was the Tufts Cochrane Fellow while he was an MPH student at the School of Medicine. 

“Having this early exposure to assessing the risk of bias or what study design would be best for a certain study, or even just how to pose a good question using specific analytical software, will make me very competitive in the workforce,” Johannesmeyer says. 

The current Cochrane Fellow is Erin Plummer, MG25 (MPH).

“I’m excited to be joining the Tufts Cochrane team this year and working on projects that improve health equity and knowledge dissemination,” Plummer says. “As a fellow, I’m hoping to gain experience in producing industry-standard systematic reviews and generally get more exposure to this aspect of translational research.”