2007 Cochrane Colloquium – Sao Paulo, Brasil

							Report from the Colloquium Policy Advisory Group to the
Steering Group Executive

Date: 25 February 2008
Prepared by: Steve McDonald and Jordi Pardo


This report is divided into Section A (Advisory Group questions) and Section B
(Topics for further discussion). The topics highlighted in Section B are:

       1. Learnings from 2007 Colloquium
       2. Location of 2010 Colloquium
       3. Central support for colloquia


SECTION A – Advisory Group Questions

1. How many meetings, and of what type (e.g. face-to-face, by teleconference), has your
   Advisory Group had since your last report in April 2007? Is this what you expected
   when you set your budget for the year?

   One meeting (Colloquium, Sao Paulo). Yes, as expected.

2. Supply an up-to-date list of the members of your Advisory Group

 First      Family          Role in CPAG                  Primary Entity
 Name       Name
 Gerd       Antes           2008 organiser                German Cochrane Centre
 Álvaro     Atallah         2007 organiser                Brazilian Cochrane Centre
 Edwin      Chan            2009 organiser                Singapore Branch of ACC
 Jonathan   Craig           CCSG representative           Renal Group
 Robert     Dellavalle      2010 organiser                Skin Group
 Norrita    Abdul Ghani     2009 organiser                Singapore Branch of ACC
 Jini       Hetherington    Secretariat representative    Secretariat
 Sally      Hopewell        Methods Group rep             UK Cochrane Centre
 Britta     Lang            2008 organiser                German Cochrane Centre
 Steve      McDonald        2005 organiser (convenor)     Australasian Cochrane Centre
 Nicola     McDowell        2006 organiser                UK Cochrane Centre
 Joy        Oliver          CCSG representative           South African Cochrane Centre
 Jordi      Pardo Pardo     2003 organiser (convenor)     Iberoamerican Cochrane Centre
 Sharon     Parker          RGC representative            Breast Cancer Group
 Rachel     Riera           2007 organiser                Airways Group
 Caroline   Rouse           2006 organiser                UK Cochrane Centre
 Baerbel    Schaetzle       2008 organiser                German Cochrane Centre
 Janet      Wale            Consumer representative       Consumer Network
 Liz        Whamond         Field representative          Consumer Network

3. Are your terms of reference and membership appropriate? Have they changed, or do
   you think they should change?

   The remit of the CPAG is ‘to maintain a record of policy decisions about Cochrane
   Colloquia, to move forward new policies after appropriate consultation, and to help
   ensure that hosts of future Colloquia know about and adhere to such policies.’

   We are happy with these terms of reference and are not advocating any change.
   However, we make the point that should the Steering Group wish to see the CPAG play
   a more active role in organising and ensuring the success of each Colloquium then the
   remit and membership would need to change, and more central support made
   available.


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4. Summarise any significant actions taken or issues raised by your Advisory Group since
   your last report, and significant actions planned between now and your next report in
   about a year’s time.

   Actions taken since April 2007
      Uploaded abstracts from Sao Paulo to the colloquium abstracts website
      Completed retrospective conversion of all colloquium abstracts (1994-2006) into
       the new colloquium abstracts website
      Revised consumer stipend documentation
      Updated terms of reference and operating procedures for the Tom Chalmers Award
      Began drafting a ‘timelines’ document that will form part of the MOU

   Plans for 2008
      Complete timelines document and draft MOU for Singapore organisers
      Update the Standard Operating Procedures
      Review and evaluate experiences with podcasting/broadcasting following 2008
       Colloquium and incorporate guidance into SOP

5. Do you foresee any problems in keeping within the budget you submitted for the
   current financial year (April to March)?

   No

6. Does your Advisory Group have any issues or questions on which you would like some
   guidance from the Steering Group? If so, please list them.

   See SECTION B

7. Does your Advisory Group wish to raise any problems, and recommended solutions,
   which you would like the Steering Group to discuss? These may be related to the
   functioning or effectiveness of the Advisory Group as a whole, or to some other
   problem. If so, please list them.

   No

8. Is your Advisory Group fulfilling an important ongoing function, or could your goals be
   achieved more effectively with a different structure?

   Current structure serves the purpose.




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SECTION B – Topics for Discussion


1.        Learnings from 2007 Cochrane Colloquium, Sao Paulo

Background
Organising a Cochrane Colloquium is a big commitment and a financial risk for
local organisers. Traditionally, the Collaboration has had minimal involvement in
the organisation of colloquia and, aside from central Collaboration funds to
maintain Event Manager (website) and support one registration per entity, has
made no direct financial contribution to the organisers1.

In recent years, the Collaboration has provided limited disaster cover in the event
of unforeseen cancellation (e.g. acts of terrorism, disease, etc.). Currently this is
set at a maximum of £40,000 ($80,000), and recognises that cancellation
insurance can be expensive or impossible to secure.

The situation with respect to central Collaboration support and financial
contribution was very different for Sao Paulo. (The CPAG was not involved in
discussions between the Brazilian organizers and the Collaboration about the level
of support or funds provided, but we understand the investment of central funds
was significant.)

While we agree that it is prudent to regularly review processes to ensure that
lessons are learnt, we feel the difficulties surrounding the Sao Paulo Colloquium
should be seen as an aberration. Cochrane colloquia have been well-organised
and most have been financially successful.

Measures to improve future Colloquia
As Nick Royle has noted, it is typically idiosyncratic of Cochrane that the
Collaboration does not have any formal agreement with Colloquium organisers
despite the Colloquium being the organisation’s annual meeting. While this
arrangement has worked in the past, recent experience demonstrates the need to
be more business-like, hence the Steering Group’s decision to have a formal
agreement (MOU) between the Collaboration and Colloquium organisers.

The following measures should help ensure Colloquium organisers are clear about
what is expected as an organiser, what support is available, what the risks are
and the extent of Collaboration support (both financial and organisational):

      -   Establish a Memorandum of Understanding between organisers and the
          Collaboration that sets out expectations, deliverables and financial
          arrangements; ensures that local organisers have a clear idea about the
          risks they are assuming and what involvement the Cochrane Collaboration
          will have
              o [One issue in relation to Sao Paulo was the communication
                  difficulties. We plan to revise the ‘Proposal to host a Colloquium’
                  form so that potential organisers are aware of the expectation that
                  members of the organising committee should be competent
                  speakers and writers of English.]
      -   Promote the use of the Standard Operating Procedures, a document
          generated after the Colloquium in Stavanger and updated after each


1
    this may not have been the case with Cape Town 2000 and Lyon 2001.



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         Colloquium highlighting the best practices identified. It also provides
         useful information to help Colloquium planning (statistics, numbers, etc.)
     -   Promote the use of the detailed reports produced after each Colloquium
         and the Colloquium Organizers Resources Collection (a website containing
         copies of letters, emails, files and other documents used for the Melbourne
         Colloquium)
     -   Establish an informal system of mentorship so that each future organiser
         has a dedicated previous organiser to approach for advice and support
     -   Consider further centralised support for Colloquium tasks, e.g. managing
         payments and logistics for Colloquia stipends (see point 3).


2.       Location of 2010 Cochrane Colloquium

Background to the CPAG’s decision to recommend Keystone
Denver was the first choice of location and Bob Dellavalle investigated several
possible venues around the city. The decision to opt for Keystone was taken after
consideration of Denver’s high venue/accommodation costs:

                              Denver (Adams Mark          Keystone
                              Hotel)
 Minimum room booking         2000 rooms (over 5          880 rooms (over 5 nights)
                              nights)
 Cost per room/night          $229                        $90-$120
 Predicted registration fee   $1150                       $850
 Deposit                      $40K                        $22K

The main reason for the difference is that October is the high season for
conferences in Denver, and so to compete with other meetings, Bob has to
guarantee to fill the hotel. When asked about the possibility of hosting the
colloquium in July or August, Bob said the prices in Denver are pretty stable
throughout the year. (October is low season in Keystone.)

In proposing Keystone, Bob has always been up-front about the issue of altitude
sickness. Members of the sub-group of the CPAG that considered the proposal all
expressed concern over the choice of Keystone for this reason. However, we felt
that Denver was not a viable option because of the higher costs and requirement
to fill so many rooms. In spite of its drawbacks, Keystone was recommended as
the only option.

Altitude sickness
As Peter Gotzsche’s paper indicates, it’s almost inevitable that altitude sickness
will be a problem for some people if Keystone is the venue. Reported incidence
rates of acute mountain sickness (AMS) range from 8% to 25% (based on
findings of interim literature review). Predicting who is at risk is notoriously
difficult and the only predictive factors are rate of ascent and previous history of
AMS. To reduce the likelihood of succumbing to AMS it is recommended that
people spend a night at a lower altitude to acclimatise. Denver would be the
obvious choice but this has implications for travel times and overall costs.

Options
Given the pros and cons of Keystone and Denver, what are the options?

        Accept Keystone
         Explain why Keystone was chosen despite the obvious health concerns; be
         very transparent about AMS; clearly warn people of the dangers and



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         recommend strategies to minimise the risks; describe what medical
         assistance will be available to those who suffer AMS.
         Accept that some people will decide not to take the risk and this may
         impact on delegate numbers and the possible viability of the colloquium.

        Reject Keystone
         Acknowledge that the risks are too high, that it may adversely affect the
         overall success of the colloquium, and that the recommended strategies to
         minimise AMS are too impractical and costly for many international
         delegates.

If Keystone is rejected, then it should be noted that:
    - Bob’s was the only proposal received for hosting the 2010 Colloquium; we
       were not informally approached by any other Cochrane centre or entity.
    - There is a cancellation fee of US $10,000 if the contract is cancelled before
       October 2009 (and the fee increases after this date)

A second US Colloquium is overdue (the first was in Baltimore in 1998) and is
important for the Collaboration’s profile in the US. If Keystone is no longer
considered appropriate then we have to accept that 1) there may not be a
Colloquium in 2010, and 2) there may not be any other individuals in the US
willing to host the Colloquium at an alternative location in the near future. (Bob
has said it’s not possible for him to undertake organising the colloquium
somewhere else.)


3.       Central Collaboration support for Colloquia

One of the positive features of Cochrane colloquia is that each meeting reflects
something of the organisers and the place. We think it’s important to preserve
the autonomy of the local organisers as a way of maintaining this unique spirit
but increasingly feel that there are areas which would benefit from greater
continuity from year to year. Stipends is one area where greater central support
has the potential to make a big difference to local organisers.

Stipends
All organisers will say how much more work was involved than they expected.
Some aspects colloquia, such as managing stipend recipients, take up a
disproportionate amount of time and having a new set of people grapple with the
same issues from year to year is not particularly efficient.

The bureaucratic restrictions on organizers’ host institutions (usually universities)
makes it virtually impossible to distribute stipend funds through the university
system. Hence the decision that the Secretariat (through Jini Hetherington) will
manage, on a pilot basis, the financial side of the consumer and developing
country stipends in 2008 is a very positive development.

If the pilot is successful, we would like to explore centralising other aspects of
stipends. Support from the Secretariat for these functions would help local
organisers and provide continuity:
     - reviewing and revising the stipend documentation (criteria, scoring
         process etc); this task is the remit of the Consumer Network and
         Developing Country Network but often falls to the colloquium organiser
         and CPAG co-convenors
     - providing secretariat support to the stipends committees




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Event Manager (website)
Since 2004, the Collaboration has provided central funds to support the
development and maintenance of Colloquium Manager and more recently its
replacement, Event Manager. The cost of purchasing and customising Event
Manager was c.£7000 with annual costs of c.£2000. We would like to see this
central support continue.

The experiences of the Freiburg organisers (first time users of Event Manager)
will be invaluable for identifying if there are other areas of colloquium
organisation that could be taken on centrally.




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