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Cochrane Acute and Emergency Care Network seeks Network Support Fellow

Thu, 08/06/2020 - 16:44
  • Contract: Fixed-term, 12 months
  • Hours: Full time, 37.5 per week (part time considered)
  • Salary: £31,365 - £37,890 per annum pro rata (dependent on experience)
  • Position Closing: 20 August 2020

Cochrane Acute and Emergency Care Network is seeking a Network Support Fellow. 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.

This job is hosted by the Cochrane Pain, Palliative and Supportive Care Review Group (PaPaS CRG) at the Churchill Hospital, part of the Oxford University Hospitals NHS Foundation Trust. Flexible (home) working will be considered, with the expectation that the post holder will attend meetings in person when required. The post is funded by the National Institute for Health Research (NIHR) to work with the Network of Cochrane Review Groups (CRGs).

The Network Support Fellow will work in support of the general aims and objectives of the CRG Transformation Plan, but with a particular focus on ensuring that the Network is positioned to provide maximum support for the NHS. The Network Support Fellow will have an individual work plan aligned to the Network’s Strategic Plan which has the following objectives:

  • supporting review production and capacity;
  • evaluating Network scope and prioritisation of topics;
  • fostering collaboration within the Network and with the wider Cochrane community;
  • supporting knowledge translation to increase the impact of Cochrane Systematic Reviews;
  • ensuring accountability and sustainability of the Network.

Please refer to the full job description and person specification for more details of the role.

Thursday, August 6, 2020 Category: Jobs

Interventions for acute severe asthma attacks in children: an overview of Cochrane Reviews

Thu, 08/06/2020 - 09:00

Interventions for acute severe asthma attacks in children: an overview of Cochrane Reviews

Asthma is a common childhood illness that is caused by narrowing of the small air passages in the lungs. This narrowing is due to swelling and inflammation and to muscles around the air passages becoming tighter. An acute asthma attack results in shortness of breath, cough, wheeze, and chest tightness.

When children have an asthma attack, the standard treatment is to give steroids to reduce inflammation and swelling (usually given by mouth) and inhaled medications to relax the muscles in the air passages (called "bronchodilators"). In this review, that standard treatment is called "first-line" treatment. These medications are well understood to be the best treatments for use in the first instance.

Some children's asthma attacks do not improve with first-line treatment, and more treatment is necessary - usually at the emergency department or hospital; in this review, we call this 'second-line' treatment. However, the best second-line treatment for children who do not respond to first-line treatment is poorly understood. Many treatment options are available, and what is done for children varies from hospital to hospital.

The author team wanted to look at existing Cochrane Reviews of second-line treatments for children having asthma attacks. They aimed to be able to bring this information together in a useful way and to present the evidence that would help the practitioner make the best treatment decision for each child having an asthma attack when inhaled bronchodilators and oral steroids have not helped with symptoms.

The overview includes 13 Cochrane Systematic Reviews on various treatment options, including inhaled medication, intravenous medications, and other therapies. This overview provides the most up-to-date evidence from systematic reviews with meta-analyses of randomised controlled trials on acute severe asthma in children. This overview is current to December 2019.

Key results

For children with acute severe asthma requiring additional treatment, the authors found that:

  • intravenous magnesium sulfate (a bronchodilator given through a vein) appears to reduce the length of time spent in hospital;
  • no evidence suggests that any treatment reduced the risk of being admitted to intensive care;
  • some treatments appeared to reduce the risk of hospital admission. These included adding a second type of inhaled bronchodilator treatment (anticholinergic medication such as ipratropium bromide) to standard inhaled treatment (beta-agonist such as salbutamol), giving intravenous magnesium sulfate, and breathing a mixture of helium and oxygen;
  • serious adverse events may be reduced by inhaled magnesium sulfate;
  • nausea and/or vomiting is more common with aminophylline (another bronchodilator medication given through a vein); and
  • adding a second type of inhaled bronchodilator treatment (anticholinergic medication such as Ipratropium bromide) reduces the risk of nausea and tremor but not vomiting.

.

Friday, August 7, 2020

Featured Review: Interventions available during pandemics for heavy menstrual bleeding: an overview of Cochrane reviews

Wed, 07/29/2020 - 12:05

What is the effectiveness and safety of treatments commonly available during pandemics for heavy menstrual bleeding?

Cochrane authors summarised the available evidence on the effectiveness and safety of treatments for heavy menstrual bleeding which can continue during pandemics.  

Pandemics impact upon the ability to deliver specialist assessment and treatments. Examples of treatments that commonly continue during pandemics include non-steroidal anti-inflammatory drugs (NSAIDs), antifibrinolytics, combined hormonal contraceptives, and progestogen.

Key findings

There is low-certainty evidence that NSAIDs (mefenamic acid) reduce heavy menstrual bleeding when compared with placebo.

There is moderate-certainty evidence that antifibrinolytics (tranexamic acid) and combined hormonal contraceptives reduce heavy menstrual bleeding when compared with placebo.

There is low-certainty evidence that antifibrinolytics (tranexamic acid) are more effective in reducing heavy menstrual bleeding when compared with NSAIDs and short-cycle progesterone

We were unable to draw conclusions about the effects of antifibrinolytics (tranexamic acid) when compared to long-cycle progesterone.

No conclusions can be made with regards to quality of life, women's satisfaction with treatment, or serious adverse events.

Dr James Duffy, Clinical Fellow, King’s Fertility, underscores the importance of the overview review, “During the COVID-19 pandemic it has become clear that the impact upon specialist assessment and treatment will continue. It is important health care professionals and women experiencing heavy menstrual bleeding have access to a Cochrane review which evaluates and summarises the evidence base for the treatments which can often continue during the pandemic.”



Decision Aid

A decision aid has been developed to support shared decision making during virtual consultations. Women with heavy menstrual bleeding helped to develop the decision aid, which draws upon the evidence summarised within the Cochrane review.



Dr Duffy adds: "Developing a decision aid alongside the Cochrane overview presents a unique opportunity to bring together the best research evidence alongside a women’s preferences, circumstances, and values. We anticipate the decision aid will support shared decision making. It is important women experiencing heavy menstrual bleeding are able to understand the range of possible treatments available, their risks and benefits, and be afforded the opportunity to consider these decisions within their own context and circumstances."

Tuesday, August 4, 2020

Special Collection - Coronavirus (COVID-19): support for wellbeing in the healthcare workforce

Wed, 07/22/2020 - 15:26

Coronavirus (COVID-19): support for wellbeing in the healthcare workforce

Many healthcare workers are at the front line of the COVID-19 pandemic, delivering emergency and critical care, while others continue to deliver the broader services of the health system in hospitals, clinics, offices, communities, and homes. Working under difficult and stressful circumstances that are likely to continue for some time, exacerbates existing risk factors such as occupational stress and shift work. Supporting the wellbeing of healthcare workers will be crucial to sustaining our health systems during and beyond the current crisis.

This Special Collection brings together Cochrane evidence on interventions that may help support the wellbeing of the healthcare workforce and reducing occupational stress.

These reviews have been produced Cochrane Review Groups in three Networks: Cochrane Mental Health and NeuroscienceCochrane Musculoskeletal, Oral, Skin and Sensory; and Cochrane Public Health and Health Systems. Some reviews in this collection have associated Cochrane Clinical Answers.

Wednesday, July 22, 2020

University of Edinburgh seeks - Research Fellow

Wed, 07/22/2020 - 12:02

The Usher Institute at the University of Edinburgh is seeking a highly skilled and motivated epidemiologist/research fellow to work in the field of vascular disease, including both the diagnosis and treatment of peripheral vascular diseases and the development of vascular complications of type 2 diabetes. The primary role will be to undertake a series of high quality systematic reviews on the prevention, diagnosis and treatment of vascular diseases, including abdominal aortic aneurysm, venous thromboembolism and peripheral arterial disease, within the core programme of work which constitutes the CSO funded research project, Cochrane Vascular, one of 25 Cochrane review groups based in the UK. The main purpose of this work is to identify key areas of clinical importance to the management of peripheral vascular disease globally, and to produce and disseminate high quality evidence to guide clinical management, using state-of-the art systematic review methodology. They will also have a data management, quality control and supervisory role for a well-established epidemiological study (the Edinburgh Type 2 Diabetes Study), which aims to identify biomarkers and potential aetiological risk factors for vascular complications affecting people with type 2 diabetes.

Applicants must have (or expect to achieve) a PhD in epidemiology or related subject, with experience of the design, conduct and reporting of large-scale randomised controlled trials, prospective cohort studies and other epidemiological study types; execution of statistical analysis; adherence to data/research governance and best practice guidelines for use of health-related data; experience of handling large data-sets in a variety of databases. Applicants will also have excellent scientific writing skills, with a good publication track record (minimum three publications in peer-reviewed journals, with at least one paper reporting analysis of an epidemiological study and/or systematic review).

The post is available from 1 August 2020 or as soon as possible thereafter, part-time (20 hours per week) and available until 31 December 2022.

Wednesday, July 22, 2020 Category: Jobs

Cochrane Rehabilitation REH-COVER (Rehabilitation – COVID-19 Evidence-based Response) action

Wed, 07/15/2020 - 10:48

In medicine, rehabilitation is a multiprofessional process aimed at enhancing and restoring functional ability and quality of life to people with impairments or disabilities. In the context of the COVID-19 pandemic, rehabilitation focuses on the sequelae of the disease as well as on the impairment due to treatments applied. COVID-19 patients may develop a myriad of acute medical problems and their treatment often requires invasive procedures: all of which can cause mid- and long-term consequences requiring rehabilitation. Rehabilitation is applied throughout the continuum of care, starting in the acute, mostly in the post-acute and continuing in the chronic phase of a disease. As well, there has been a disruption of  regular rehabilitation of people with disabilities and chronic diseases due to quarantine, social isolation, movement restriction, and other healthcare systems’ disruptions. Given the current COVID-19 situation, having the best available rehabilitation evidence is even more important to help reduce clinical uncertainty. 

To update the rehabilitation community on the growing evidence for the role of rehabilitation in management of COVID-19 patients, Cochrane Rehabilitation launched the REH-COVER (Rehabilitation – Covid-19 Evidence-based Response) action.

The aim of this action is to focus on the timely collection, review, and dissemination of summarized and synthesized evidence relating to COVID-19 and rehabilitation. This will create an evidence-based answer repository to the newly-risen clinical questions and problems. The action was developed by an international multi-professional Steering Committee, whose role will continue to advise on all initiatives included in this action.

Cochrane Rehabilitation REH-COVER action currently includes four main initiatives:

  1. Rapid living Systematic Reviews on Rehabilitation and COVID-19 updates published monthly
  2. Interactive living evidence map on Rehabilitation and COVID-19 
  3. Definition of the research topics on “Rehabilitation and COVID-19” in collaboration with the WHO rehabilitation programme 
  4. Forthcoming Cochrane Library Special Collection: Coronavirus (COVID-19): rehabilitation of patients with functional consequences of acute illness and its treatments, will be published soon

Other initiatives under development include:

  1. Living Systematic Review on “current evidence on rehabilitation of patients with functional consequences of COVID-19 and its treatments”:  results expected in July 2020
  2. Collaboration with COVID-END for the topics “rehabilitation” and “disability”: discussion started in June 2020
Wednesday, July 15, 2020

Featured review: Improving access to food in low- and middle-income countries

Tue, 07/14/2020 - 08:37

The number of people who do not have enough to eat in the world has been increasing since 2015. Most of these people live in low- and middle-income countries (LMICs), especially in Asia and Africa. Food insecurity is when people do not have physical, social and economic access to sufficient, safe, nutritious foods to be healthy. That is, they do not have enough money to buy food, or do not have anywhere to shop or cannot find food near to where they live. Food insecurity affects the health, social and economic situation of individuals and communities.

COVID-19 and food insecurity Food insecurity has increased as a result of measures implemented throughout the world to prevent the spread of COVID-19.   ‘Lockdowns’ restrict people’s movement and their ability to work, leading to loss of income and livelihoods, particularly for people in the informal economy. This, in turn, limits people’s physical and economic access to food. Disruptions to food supply, from harvesting to transport to labour supply, negatively affect food prices and availability. School closures affect millions of children who access food through school meal schemes. The effects of lockdown are felt everywhere, but disproportionally affect poor and vulnerable people. 

This Cochrane Review looked at the effect of community-level interventions on individuals, households and communities in LMICs to improve access to nutritious food. The main outcome was food security, measured by prevalence of undernourishment, proportion of household expenditure on food, and proportion of people and households who ate a diverse diet, that is, a variety of foods from different food groups. Other outcomes reflected nutritional status, such as how well children grew (stunting), low body weight (wasting) and cognitive function (thoughts and understanding).

Key results
The review authors found 59 studies that assessed different interventions, mainly in Africa and Latin America. Many studies assessed cash transfers, which are welfare programmes where money is provided to households. Of these, 21 studies evaluated unconditional cash transfers, where there are no conditions for receiving the money, and 14 studies assessed conditional cash transfers, where people had to meet specific conditions in order to receive the money. Seventeen studies looked at income generation interventions (for example, livestock management or self-help groups), four studies at food vouchers, four studies at providing food and nutrition subsidies, and two studies looked at social support interventions such as village savings and loans and community grant programmes.

Unconditional cash transfers improve food security but make little or no difference to cognitive function or development. They may increase dietary diversity and may reduce stunting. It is very uncertain whether unconditional cash transfers reduce the proportion of household expenditure on food or reduce wasting. Evidence from one study indicates that unconditional cash transfers reduce the proportion of infants who are overweight.

Conditional cash transfers make little to no difference in the proportion of household expenditure on food and slightly improve cognitive function in children, probably slightly improve dietary diversity, and may make little to no difference to stunting or wasting. Evidence from two studies shows that conditional cash transfers make no difference to the proportion of overweight children.

Income generation strategies make little or no difference to stunting or wasting, may result in little to no difference to food security and may improve dietary diversity in children but not for households.



Food vouchers probably reduce stunting, may slightly improve dietary diversity and may result in little to no difference in wasting.

Food and nutrition subsidies may improve dietary diversity among school children. We are very uncertain about the effects on household expenditure on healthy foods as a proportion of total expenditure on food.

Social support interventions such as community grants probably make little to no difference to wasting and may make little or no difference to stunting. We are very uncertain about the effects of village savings and loans on food security or dietary diversity.

None of the included studies reported on one of the primary outcomes: prevalence of undernourishment.

Conclusions
This review provides policy makers with a comprehensive evidence base to evaluate the effects of a wide range of community-level interventions to address access to food in low- and middle-income countries (LMICs). The body of evidence indicates that UCTs can improve food security but the review authors are less sure about the effects of other interventions. Some limitations of the review include not having all necessary information about what outcomes the studies measured, having to make judgements regarding which outcome measures to report and inability to pool the results of all studies reporting on the same outcome. Another limitation was that the review authors were unable to find out what specific intervention features enable or impede the effective implementation of the intervention.

Wednesday, July 29, 2020

Two Cohrane Croatia members receive awards from the city of Split for 2019

Wed, 07/08/2020 - 18:03

Irena Zakarija Grković, co-director of Cochrane Croatia, and Matko Marušić, head of quality assurance at Cochrane Croatia, both received awards from the city of Split.  

The Split City Council, on May 4, 2020, decided that the traditional awards of the city of Split should be given to two members of the Cochrane Croatia. The personal award was given to Irena Zakarija Grković, co-director of Cochrane Croatia, for selfless commitment and work on the popularization of breastfeeding. A second award was given to Matko Marušić, head of quality assurance at Cochrane Croatia, for the book "Mi Hrvati". 

Irena is a family medicine specialist and an internationally certified breastfeeding counsultant (IBCLC) and president of the Croatian association of IBCLC breastfeeding consultants (HUSD). She became a specialist in Melbourne, Australia, where she gained twelve years of clinical experience working with various groups of patients, especially people with special needs and Croatian-speaking emigrants. There she also became an internationaly certified breastfeeding consultant. Her areas of scientific, teaching and professional interest are breastfeeding and the protection of mothers and children, evidence-based medicine and education in basic clinical and communication skills, and she has published numerous scientific papers in these areas. She is a member and founder of the National commission for the protection and promotion of breastfeeding at the Croatian Ministry of Health, an educator in the UNICEF program "Baby-Friendly Maternity Hospital" and an assistant professor at the Department of Clinical Skills and co-head of Cochrane Croatia. 

Matko is one of the leading Croatian scientists, writer and professor emeritus of the University of Split. He graduated from the University of Zgreb, School of Medicine, where he graduated in 1970 with the Rector's award for Best student. Since 1971 he has been working as an assistant at the Department of Physiology of the School of Medicine in Zagreb, where he received his doctorate in 1976. He became a professor at the School of Medicine in 1980. He is the author of numerous works in the field of medical science as well as literary works. He described his childhood in the book "Snijeg u Splitu", which he dedicated to his eldest son Berislav. The book has been reprinted several times since 1987, and is also read as part of primary school reading. His second book, "Plaču li anđeli?" (1997) was dedicated to his son Stjepan Ljudevit. In that book, he described the horrors of the Croatian War of Independence and described the people who fought against and evil and superior enemy, and the victory of good people. Since he wrote books for his children, he also wrote the book "Škola plivanja" for his youngest daughter Maria Franka. In that book, which was published in 2005, she describes Marija’s growing up, narrating innocently and with parental love. In 2006, he published the book "Medicina iznutra", in which he spoke openly about various aspects of life in medical profession, including corruption. In 2019, he published the book "Mi Hrvati" as his long-term project made out of love for the Croatian people. As a professor at the School of Medicine in Zagreb, he was elected vice dean of regional medical studies in Split and Osijek in 1982 and is credited with founding today's School of Medicine in Split (1997), where he was dean from 2009 to 2010 and the School of Medicine in Osijek (1998). He also provided significant assistance in establishing the School of Medicine of the University of Mostar. In 1990, he started Croatian Medical Journal, which he edited and managed until 2011. He has published over 250 scientific papers, of which more than 190 in internationally indexed journals. His most internationally recognized scientific contribution is in the research of the thymus, and on immunology in bone marrow transplantation. 

We warmly congratulate Irena and Matko on the great recognition of the city of Split!

Wednesday, July 8, 2020

Featured Review: Psychological interventions for psychosis in adolescents

Wed, 07/08/2020 - 14:00

Are psychological interventions effective and safe for adolescents with psychosis? Are there any differences in effect between different psychological interventions? New Cochrane systematic review looks at the available evidence. 

 

 

Psychosis is a mental illnesses characterised by alterations in thoughts and perceptions as delusions (false beliefs), hallucinations (seeing or hearing things that others do not see or hear) and can happen during adolescence. When this happens, the young person needs to see a mental health professional who will often prescribe medications. However, along with medications, adolescents with psychosis are likely to benefit from age‐appropriate psychological treatments (talking treatments) such as cognitive remediation therapy, psychoeducation, family therapy and group psychotherapy. These interventions can address social and psychological needs such as integration with peers and deal with the stigma and exclusion. We have reviewed the effects of these interventions for young people with psychosis using data from randomised controlled trials.

The Information Specialist of Cochrane Schizophrenia searched their trials register in May 2016 and March 2019 for trials that randomly allocated adolescents with psychosis to various treatment groups. The treatment groups could include either psychological interventions (with or without their usual treatment), medications alone, treatment‐as‐usual or other psychological interventions (with or without usual treatment).

This review includes only seven trials conducted in various parts of the world. The trials compared a variety of different psychological interventions with treatment‐as‐usual or with other types of psychological interventions, and they reported different outcome measures, making it difficult for us to compare one study with another. We were interested in the effect these treatments have on seven main outcomes: global state, mental state, adverse effects, cognitive functioning, global functioning, service use, and leaving the study early. None of the included studies reported adverse effect data.

Results

Absolute effect of psychological interventions (PIs, comparing PIs with treatment‐as‐usual (TAU))

Our analyses of reported data suggests that cognitive remediation therapy may help improve short term memory (a cognitive function) but treatment‐as‐usual may be better than CRT for improving mental state. Group therapy may be also be useful for improving global state. All other analyses for the main outcomes showed PIs had little or no effect compared to TAU.

Relative effects of PIs (comparing one type of PI with another type of PI)

Our analyses showed no real differences between the different types of PIs.

 

Conclusions

Some psychological interventions may have beneficial effects for selected outcomes but, overall, most results suggest little or no effect. However, all our results were based on data from a very small number of studies with small numbers of participants. We also have concerns with the methods used in these studies. Thus, there is considerable uncertainty about the reliability of these findings. We cannot make firm conclusions based on this evidence. Relevant well‐conducted randomised controlled trials are needed.

Wednesday, July 8, 2020

Conflict of Interest Panel – Call for expressions of interest

Tue, 07/07/2020 - 15:32

Cochrane invites expression of interest in joining our Conflict of Interest Panel. This independent panel  will work with Cochrane’s Research Integrity Team to arbitrate on potential breaches of the revised Cochrane Conflict of Interest Policy for Cochrane Library Content and provide general guidance on how the policy should be applied. The panel will be take up it’s duties when the revised policy is launched in October 2020.

The panel will work on a voluntary basis and have a maximum of four persons and will be appointed by the Editor in Chief (EIC) in consultation with the Senior Research Integrity Editor. The panel members will select a chair from among the membership of the panel.  The Chair will be the main contact person for the panel, will convene virtual or face-to-face meetings of the panel, and consult with the panel as needed.

Responsibilities
The duties of the panel are as follow: 

  • Review cases and make decisions on individual cases referred according to specified time frames.
  • Respond to queries about the COI policy generally
  • Comment on revisions of the COI policy
  • Provide advice when the Editorial & Methods Dept conducts an audit of compliance to the policy
  • Prepare an annual report of Panel activity for the EiC
  • Participate in training activities that support those creating Cochrane Library content to adhere to the policy
  • Assist in the development of supporting materials (e.g. FAQs)

Qualifications
Applicants must have no financial conflicts of  interest. In addition the following knowledge and/or experience are desirable:

  • Experience serving on or chairing a COI committee or its equivalent (or similar committees. such as academic-industry relations committees)
  • Experience with drafting and / or implementing conflict of interest policies (ideally related to research or health policies, such as guidelines)
  • Familiarity with the literature on identifying, managing and impact of conflicts of interest in health
  • Familiarity with journal policies related to conflicts of interest
  • Experience as a Cochrane member or knowledge of  Cochrane 

Time commitment
Variable, estimated at 3-4 hours per month, which includes attendance at meetings as necessary.

Duration of term
The term of the Panel members is two years, with the possibility of another two-year term, to a maximum of four years. 

Support
Administrative support and co-ordination will be provided by the Research Integrity Team, in the Editorial & Methods Department.

Submissions & closing date
Any questions about panel membership and expressions of interest (in the form of a brief cover letter) should be submitted to COIarbiter@cochrane.org

Deadline for expressions of interest: July 31st, 2020

Tuesday, July 7, 2020

Featured Review: Psychological interventions to foster resilience in healthcare professionals

Tue, 07/07/2020 - 15:22

The work of healthcare professionals (e.g. nurses, physicians, psychologists, social workers) can be very stressful. They often carry a lot of responsibility and are required to work under pressure. This can adversely affect their physical and mental health. Interventions to protect them against such stresses are known as resilience interventions. Previous systematic reviews suggest that resilience interventions can help workers cope with stress and protect them against adverse consequences for their physical and mental health.



Cochrane review authors asked, “do psychological interventions designed to foster resilience improve resilience, mental health and other factors associated with resilience in healthcare professionals?” This question is particularly relevant at the moment, when healthcare workers are under great pressure due to COVID-19.

Review authors searched for studies up to June 2019. They found 44 studies that tested a range of resilience interventions. Thirty-nine studies included healthcare professionals only (6892 participants). Four studies included healthcare professionals and non‐healthcare workers (1000 participants). The remaining study examined 82 volunteer emergency workers.

Nineteen studies compared a combined resilience intervention (e.g. mindfulness and cognitive‐behavioural therapy) with unspecific comparators (e.g. a wait‐list control). Most interventions were performed in face-to-face, in groups, with high training intensity of more than 12 hours or sessions.

The review authors found very low-certainty evidence that resilience training may improve resilience in healthcare professionals, and may reduce symptoms of depression and stress immediately after the end of treatment. Resilience interventions do not appear to reduce anxiety symptoms or improve well‐being. Very few studies reported on the longer‐term impact of resilience interventions. Only three studies examined potential adverse events and found no undesired effects.



Studies used a variety of different outcome measures and intervention designs, making it difficult for the review authors to draw general conclusions from the findings. The evidence that they found in this review is limited and very uncertain. This means that, at present, the review authors have very little confidence that resilience interventions make a difference to healthcare workers’ resilience.

The review authors will include results of an updated search of four key databases carried out in June 2020 when they update their review.

Wednesday, July 8, 2020

Featured Review: Can symptoms and medical examination accurately diagnose COVID-19 disease?

Mon, 07/06/2020 - 20:55

A new systematic review from Cochrane Infectious Diseases Group  published today; 'Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease'.

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. Most people with COVID-19 have a mild to moderate respiratory illness; others experience severe illness, such as COVID-19 pneumonia. Formal diagnosis requires laboratory analysis of nose and throat samples, or imaging tests like CT scans. However, the first and most accessible diagnostic information is from symptoms and signs from clinical examination. If initial diagnosis by symptoms and signs were accurate, the need for time-consuming, specialist diagnostic tests would be reduced.

Symptoms are experienced by patients. People with mild COVID-19 might experience cough, sore throat, high temperature, diarrhoea, headache, muscle or joint pain, fatigue, and loss of sense of smell and taste. Symptoms of COVID-19 pneumonia include breathlessness, loss of appetite, confusion, pain or pressure in the chest, and high temperature (above 38 °C).

Signs are evaluated by clinical examination, and include lung sounds, blood pressure and heart rate.

Often, people with mild symptoms visit their doctor (primary care physician) for an initial diagnosis. People with more severe symptoms might visit a hospital outpatient or emergency department. Depending on their symptoms and signs, patients may be sent home to isolate, may receive further tests or be hospitalised.

Why is accurate diagnosis important?
Accurate diagnosis ensures that people receive the correct treatment quickly; are not tested, treated or isolated unnecessarily; and do not risk spreading COVID-19. This is important for individuals and saves time and resources.

We wanted to know how accurate diagnosis of COVID-19 and COVID-19 pneumonia is in a primary care or hospital setting, based on symptoms and signs from medical examination.

What did we do?
We searched for studies that assessed the accuracy of symptoms and signs to diagnose mild COVID-19 and COVID-19 pneumonia. Studies could include people with possible COVID-19, or people known to have – and not to have – COVID-19. Studies had to be in primary care or hospital outpatient settings only and include at least 10 participants with any symptom or sign that might be COVID-19.

The included studies
We found 16 relevant studies with 7706 participants. The studies assessed 27 separate signs and symptoms, but none assessed combinations of signs and symptoms. Seven were set in hospital outpatient clinics (2172 participants), four in emergency departments (1401 participants), but none in primary care settings. No studies included children, and only one focused on older adults. All the studies confirmed COVID-19 diagnosis by the most accurate tests available.

The review authors searched for studies published from January to April 2020.

Main results
The studies did not clearly distinguish mild to moderate COVID-19 from COVID-19 pneumonia, so we present the results for both conditions together.

The results indicate that at least half of participants with COVID-19 disease had a cough, sore throat, high temperature, muscle or joint pain, fatigue, or headache. However, cough and sore throat were also common in people without COVID-19, so these symptoms alone are less helpful for diagnosing COVID-19. High temperature, muscle or joint pain, fatigue, and headache substantially increase the likelihood of COVID-19 disease when they are present.

How reliable are the results?
The accuracy of individual symptoms and signs varied widely across studies. Moreover, the studies selected participants in a way that meant the accuracy of tests based on symptoms and signs may be uncertain.

Conclusions
All studies were conducted in hospital outpatient settings, so the results are not representative of primary care settings. The results do not apply to children or older adults specifically, and do not clearly differentiate between milder COVID-19 disease and COVID-19 pneumonia.

The results suggest that a single symptom or sign included in this review cannot accurately diagnose COVID-19. Doctors base diagnosis on multiple symptoms and signs, but the studies did not reflect this aspect of clinical practice.

Further research is needed to investigate combinations of symptoms and signs; symptoms that are likely to be more specific, such as loss of sense of smell; and testing unselected populations, in primary care settings and in children and older adults.

Tuesday, July 7, 2020

Cochrane recognizes its first Knowledge Translation mentors and mentees

Fri, 07/03/2020 - 22:40

Cochrane is proud to recognize participants and collaborators from its global community who have been part of its first Knowledge Translation virtual mentoring programme. 

Twelve pairs of mentors and mentees took part in the pilot, coordinated by Cochrane’s Knowledge Translation (KT) Department, between September 2019 and March 2020,  with the aim of developing skills, as well as passing on expertise, in knowledge translation. 

We were delighted to receive huge interest in the scheme with 38 members of the Cochrane community applying to be mentees and 25 people from within and outside of Cochrane volunteering to act as KT mentors. 

Mentors and mentees were matched, received online training and guidance, and then met together over six months to work on their projects. You can read a full summary of the KT Mentoring programme  here as well as finding out what happens next with this programme. 

We wish to pass on a huge thank you to all our KT mentors and mentees for their hard work and commitment. Here are a few of their stories:

Eve Tomlinson, Network Support Fellow for the Cochrane Cancer Network, has been a mentee in the KT mentorship programme. She worked on a project to map stakeholders for Cochrane Review Groups and the Network overall, with the ultimate goal of facilitating stakeholder engagement in review production and knowledge translation activities in the Network. She says of her decision to undertake this project with the KT mentoring program, “I applied for mentoring in the hope that I would receive guidance from someone with relevant experience to help me deliver the project and ensure it was useful for Cancer CRGs. As someone who enjoys KT, I was also keen to have a fellow KT-enthusiast to speak to about KT within Cochrane!” From the successful completion of this project, Eve worked within the CRG to identify 180 stakeholders working toward common goals in cancer research, and she is working with some cancer CRGs on stakeholder engagement. She wrote a guest blog for Cochrane about this project; read it here

Michael McEvoy applied for the mentorship program as a dissemination fellow for the Cochrane Anaesthesia Review Group (CARG). Working with his mentor, he undertook to increase engagement with reviews from CARG, combining “background” dissemination (such as writing summaries of reviews for newsletters, social media etc) with big projects (such as promoting reviews to authors of national guidelines). He is most proud of the Regional Anaesthesia Special Collection that he helped create as part of this mentoring program, which became highly relevant during the COVID-19 pandemic and generated significant interest and was widely read. Of the mentoring experience, he says, “It was incredibly useful and the project would not have been as successful without it. The mentoring applies some pressure to make sure you progress with your project without it being challenging or critical. It helped me feel more integrated into Cochrane and meet someone from a different group and it encouraged me to think about how I could continue to work more with Cochrane in the future.” 

In summary, participants spoke passionately about how they found virtual mentoring hugely valuable for their own learning and would like to see the programme repeated and more opportunities for developing KT skills in the future. Two-thirds of mentees reported feeling more confident about understanding and applying KT practices in their work, and mentors spoke about feeling valued and developing their own thinking and ideas as a result of having a new challenge. 

Recognizing the success of this first programme, Cochrane will form a second cohort of mentoring pairs, and seek applications for participants from September 2020.

Learn more about the pilot programme

Find out more about Knowledge Translation in Cochrane

Knowledge Translation Department 

Monday, July 6, 2020

Featured Review: Induction of labour at or beyond 37 weeks’ gestation

Thu, 07/02/2020 - 15:20

A normal pregnancy lasts about 40 weeks (the gestation period) from the start of the woman's last menstrual period. If a pregnancy lasts too long, a woman and her clinician may wish to stimulate the woman’s body to begin labour. This is called induction.

Babies may be at a greater risk of death, before or shortly after birth, after prolonged gestation. However, induction of labour may also have risks for mothers and their babies, especially if women are not ready to labour.

Current tests cannot predict whether babies would be better to stay inside their mother or whether labour should be induced to make the birth happen sooner. Many hospitals therefore have policies for how long pregnancies should continue.

This updated Cochrane systematic review examined whether inducing labour at or beyond 37 weeks' gestation, could reduce risks for the babies.

The studies
The authors identified 34 studies with more than 21,000 women that compared a policy to induce labour, usually after 41 completed weeks of gestation, with waiting for labour to start or waiting for a period before inducing labour, or both. The studies took place in Austria, Canada, China, India, Finland, Malaysia, Netherlands, Norway, Russia, Spain, Sweden, Thailand, Tunisia, Turkey, UK and USA.

Results
There were fewer deaths of babies in hospitals that had a policy to induce labour after a certain time compared with waiting for labour to start naturally. There were fewer admissions to the intensive care nursery and fewer low Apgar scores at five minutes after birth (a simple health test for babies) in the induction groups compared with waiting.

Fewer caesarean births were required with induction compared with waiting, with similar rates for assisted vaginal birth, whether induced or not.

The authors did not find any clear differences between waiting for labour to start naturally compared with a policy to induce labour at or later than 37 weeks in: the risks of mothers having trauma to their perineum; bleeding after birth; the length of mothers' stay in hospital; breastfeeding; babies having early abnormal neurological function (encephalopathy); or birth trauma.

None of the trials provided information on postnatal depression or child development.

Certainty of the evidence
Most included studies were well conducted and well reported. The authors’ certainty (confidence) in the evidence is generally moderate to high.

Key message from this review
A policy of labour induction compared with waiting for labour to start is associated with fewer deaths of babies and fewer caesarean sections; with no clear difference in assisted vaginal births. While the optimal time for induction in low-risk women is not yet clear, offering women tailored counselling may help them to make an informed choice between induction of labour for pregnancies - particularly those continuing beyond 41 weeks – and waiting for labour to start naturally, or waiting a specified time before inducing labour. Counselling needs to ensure that women's values and preferences are discussed.

The review includes evidence published up to 17 July 2019.

  • Read the full review here
  • Visit the Cochrane Pregnancy and Childbirth group here
Wednesday, July 15, 2020

Featured Review: Psychological therapies for women who experience intimate partner violence

Thu, 07/02/2020 - 09:42

Interview with Kelsey Hegarty, Professor Family Violence Prevention, The University of Melbourne and The Royal Women's Hospital and lead author of this Cochrane Review.

Tell us about this Cochrane review…
Domestic violence (physical, emotional, sexual abuse and controlling behaviour by a partner or ex‐partner) is common worldwide and causes long‐lasting emotional and physical health problems. Psychological therapies (counselling by trained people) may improve women's mental health and enable them to focus on making safety plans, accessing resources for themselves and their children, and ultimately to escape the domestic violence.



We searched scientific literature worldwide up to the end of October 2019 for trials comparing a group of female domestic violence survivors who received psychological therapy with those who did not, to understand whether such therapies are safe and effective.

What did you find out?
We found evidence that psychological therapies probably reduce depression and may reduce anxiety symptoms for women who have experienced domestic violence (six to 12 months after the therapy). Psychological therapies do not appear to cause any harm. However, we are uncertain whether psychological therapies improve self‐efficacy, mental health, quality of life, social support, uptake of healthcare and domestic violence services, safety planning or reduce post‐traumatic stress disorder and re‐exposure to any form of domestic violence.

Overall, there is a need for more trials with consistent outcomes at similar follow‐up time points as we were unable to combine much of the research to give an overall picture.

Thus, while women experiencing domestic violence may be helped by psychological therapies to improve their emotional health, which may in turn help their ongoing needs of safety, support and holistic healing from complex trauma, we are uncertain whether psychological therapies improve these aspects of their live

During the COVID-19 pandemic and resulting movement restrictions an upsurge in domestic violence has been reported. What can this review tell us about treatment for women who have experienced intimate partner violence during this time?
Access to help is a real issue during the COVID pandemic for both domestic violence and mental health issues. This review tells us that psychological therapies are likely to improve depression and anxiety symptoms. Some of these therapies are being offered online or through telehealth during COVID so may assist women experiencing IPV. However, their partner may be monitoring their use of technology and it may not be safe for them to receive this help.



Given the world-wide rise in violence against women during the pandemic, how can this review help decision makers facing decisions about where to invest resources? And help clinicians decide the best course of action?
This review reassures decision makers that psychological therapies help women with their emotional health, however currently there is no evidence that it assists with safety issues or healing in a broader sense. Therefore, investment in resources that address these issues as an integrated package would be helpful. Clinicians should be aware of ensuring they know how to address safety in addition to offering therapy.

How can this review help women who have experienced intimate partner violence who want to seek out help?
Women who feel as if their emotional health is something that they want help with can be reassured that in the context of IPV psychological therapies may assist them to feel better. This in turn may help them to take action on a pathway to safety and healing. However, more research is needed as there were limited studies to draw on.

Thursday, July 2, 2020

#MyCochraneStory

Thu, 06/25/2020 - 20:38

Cochrane's strength is in its collaborative, global community.  Our 82,000 members and supporters from more than 130 countries work together to produce credible, accessible health information and help inform health decision making. Though we are spread out across the globe, our shared passion for health evidence unites us. 

We want to come together and tell our collective and individual Cochrane stories! To share your #MyCochraneStory please contact  Rachel Klabunde - rklabunde@cochrane.org - with the following:

  • A photo: At your desk, at Cochrane event, something beyond a headshot.
  • Your country of residence: Are community is diverse and we want to celebrate this!
  • Your Cochrane Story: We want to hear about  what Cochrane work and achievements you are most proud of! 3-4 sentences about yourself and your story and any URLs that could be included.

Rachel Klabunde, from Chile, joined Cochrane in 2019 helping the Cochrane Chile team to plan the 2019 Cochrane Colloquium in Santiago. She now work as part of the Community Support team in People Services and as a Communication Officer in the Knowledge Translation Department of the Cochrane Central Executive Team. Due to widespread violence and civil unrest in Santiago, the annual Colloquium gala dinner was canceled. Our annual event would have featured a four-day wide-reaching scientific programme entitled ‘Embracing Diversity’ as well as a Gala Dinner open to all delegates. Due to the cancellation, all the pre-ordered food including catering provisions for a three-course Gala dinner was donated to a local charity in Santiago. Turning this negative moment into something positive is definitely something to be proud of!

Muriah Umoquit, from Canada, joined Cochrane in 2015. Working in the Knowledge Translation Department of the Central Executive Team, she  is a self-proclaimed 'Cochrane Fangirl'. Knowing how daunting rows of academic posters can be, she was thrilled to work on a project bringing branded #BetterPoster templates to disseminate Cochrane work at Colloquiums and other academic conferences.  You can view many of these posters from our virtual 2019 Colloquium - including hers!

 

We want to come together and tell our collective and individual Cochrane stories! To share your #MyCochraneStory please contact  Rachel Klabunde - rklabunde@cochrane.org - with the following:

  • A photo: At your desk, at Cochrane event, something beyond a headshot.
  • Your country of residence: Are community is diverse and we want to celebrate this!
  • Your Cochrane Story: We want to hear about  what Cochrane work and achievements you are most proud of! 3-4 sentences about yourself and your story and any URLs that could be included.
Thursday, June 25, 2020

Cochrane supports Vivli’s accelerated process for sharing data from COVID-19 trials

Wed, 06/24/2020 - 21:54

Members of Vivli, the Center for Clinical Research Data, have announced their commitment to share their COVID-19 trials through Vivli. Members who have committed to sharing their data on the COVID-19 portal, a dedicated search function within Vivli for COVID-19 include Eli Lilly & Company, Regeneron, Roche, Takeda. 

Cochrane has previously partnered with Vivli by helping to provide vocabulary for the search platform and has expressed support of these efforts toward sharing COVID-19 data.

“Coronavirus is currently the most searched term on the Vivli platform and the new search experience is coupled with an accelerated process for data sharing. We believe that now, more than ever, sharing the individual participant data that underpins trial results is vital to driving forward both new science as well as scientific consensus,” said Rebecca Li, Vivli Executive Director.

“Vivli will continue to waive the fees for sharing for any interventional trial related to COVID-19 and to make the process as easy as possible. You don’t have to be a member to share your data using Vivli. We can and do share data from researchers from industry, academia, and non-profits. We have also partnered with vendors who can anonymize these datasets who have offered to anonymize the datasets waiving their normal fees. Vivli is doing all it can as part of the wider ecosystem of the health research community who are collaborating and coming together to do everything we can to find a treatment or vaccine for COVID-19.”

Vivli provides researchers with a secure, easy-to-use online platform to archive and share clinical trial data across all diseases and research entities. Vivli also allows researchers to combine and analyze data from multiple trials using state of the art tools.

Editor in Chief of the Cochrane Library, Karla Soares-Weiser said, “The pandemic represents a significant threat to global health, high quality evidence to inform decision making is needed urgently. Now, more than ever, fast, shared access to trial data is needed. Cochrane is pleased to support this initiative from Vivli as it promotes research integrity, transparency and acknowledges the value of timely and responsive production of evidence.”

About Vivli

Vivli is a non-profit organization working to advance human health through the insights and discoveries gained by sharing and analyzing data. It is home to an independent global data-sharing and analytics platform which serves all elements of the international research community. The platform includes a data repository, in-depth search engine and cloud-based analytics, and harmonizes governance, policy and processes to make sharing data easier. Vivli acts as a neutral broker between data contributor and data user and the wider data sharing community. For more information, visit www.vivli.org and follow us on Twitter @VivliCenter.

Wednesday, June 24, 2020

New Cochrane review assesses how accurate antibody tests are for detecting COVID-19

Wed, 06/24/2020 - 14:00

Today Cochrane, a global independent organization that reviews evidence from research to inform health decision-making, publishes a review of studies looking at the accuracy of COVID-19 antibody tests. 

The review shows that antibody tests could have a useful role in detecting if someone has had COVID-19, but that timing is important. The tests were better at detecting COVID-19 in people two or more weeks after their symptoms started, but we do not know how well they work more than five weeks after symptoms started. We do not know if this is true for people who have milder disease or no symptoms, because the studies in the review were mainly done in people who were in hospital. In time, we will learn whether having previously had COVID-19 provides individuals with immunity to future infection.

Antibody tests are an important public health tool to identify individuals with previous COVID-19 disease. This enables assessment of the spread of infection and the need for public health interventions.  The review summarizes research evidence available up until the end of April 2020 to see whether antibody tests: 

  • are accurate enough to diagnose disease in people with or without symptoms of COVID-19, and 
  • can be used to find out if someone has already had COVID-19.

The immune system of people who have COVID-19 responds by developing proteins in the blood called antibodies that attack the virus. Detecting antibodies in people’s blood may indicate whether they currently have COVID-19 or have had it previously.  Whilst detecting current infection is usually done using swab tests within the first 5 days of illness, they may miss infection and are not available to all.  

Cochrane researchers from universities across the world led by experts from the University of Birmingham searched through the 11,000 publications on COVID-19 available at the end of April to find studies that reported results of antibody tests in groups of people known to have (or have had) COVID-19 and others known not to have had COVID-19 based. They found a total of 54 relevant studies reporting test results for nearly 16,000 samples. The majority of studies were from China and were carried out in people who had been admitted to hospital and likely to have had severe disease. 

The studies looked at three types of antibody, IgA, IgG and IgM. Most tests measured both IgG and IgM, but some measured a single antibody or combinations of the three antibodies. Data were only available for 27 tests, a small fraction of the over 200 tests on the market. Data were available on both laboratory based tests, which require blood samples taken from the veins, and point-of-care tests, which can use finger-prick blood samples. There were not enough data to compare the accuracy of different tests. The authors will continue to update this review over the next few months to provide a more complete summary of the research evidence as it accumulates.

The researchers found that the sensitivity (the proportion of the people who have had COVID-19 that the test can detect) of antibody testing is very closely related to when the test is performed. Tests of the IgG and IgM antibodies at 8 to 14 days after onset of symptoms correctly identified only 70% of people who had COVID-19. However, when the researchers looked at data reported at between 15 and 35 days after symptoms first began, antibody tests accurately detected over 90% of people with COVID-19. There are insufficient studies to estimate the sensitivity of antibody tests beyond 35 days after the beginning of symptoms.  The tests only wrongly diagnosed COVID-19 in 1% to 2% of people without COVID-19.

To illustrate what these accuracy figures mean, in a sample of 1000 people where 200 people (20%) really have COVID-19, typical of workers in a hospital setting where COVID-19 patients have been treated:

  • 193 people would receive a positive test result but 10 (5%) of those people would not have COVID-19 (known as a false positive result);
  • 807 people would receive a negative test result but 17 (2%) of those people would have COVID-19 (known as false negative result).

In a population where COVID-19 was more common there would be more false negatives and fewer false positives.

Studies showed that antibody tests may have a role in diagnosing COVID-19 in patients who have had COVID-19 symptoms for two or more weeks but who have not had a swab (PCR) test or tested negative despite COVID-19-like symptoms.

Professor Jon Deeks, Professor of Biostatistics and head of the Test Evaluation Research Group at the University of Birmingham, explains: “We’ve analyzed all available data from around the globe - discovering clear patterns telling us that timing is vital in using these tests. Use them at the wrong time and they don’t work. While these first COVID-19 antibody tests show potential, particularly when used two or three weeks after the onset of symptoms, the data are nearly all from hospitalized patients, so we don’t really know how accurately they identify COVID-19 in people with mild or no symptoms, or tested more than five weeks after symptoms started.

The researchers also had several concerns about the quality of the studies they found. Studies were small and did not report their results fully. Many papers included multiple samples from the same patients. More than half of the studies were made available before they had been through peer review (publications known as ‘preprints’). In one important UK study the biomarker manufacturers did not approve the identification of the tests that had been evaluated.

Dr Jac Dinnes, who worked on the review with the University of Birmingham team commented, “The design, execution and reporting of studies of the accuracy of COVID-19 tests requires considerable improvement. Studies must report data broken down by time since onset of symptoms. Action is needed to ensure that all results of test evaluations are available in the public domain to prevent selective reporting. This is a fast-moving field and we plan to update this review regularly as more studies are published.” 

 

Thursday, June 25, 2020

What is the difference between a Cochrane systematic review of interventions and a Cochrane diagnostic test accuracy review?

Tue, 06/23/2020 - 17:34

Cochrane systematic reviews of interventions (intervention reviews) and Cochrane diagnostic test accuracy reviews (DTA reviews) are two types of systematic review.

They share the following characteristics:

  • They aim to answer a specific healthcare question to help people make decisions based on up-to-date evidence from research. 
  • They look for all the relevant studies to answer the review question.
  • They appraise the reliability of the studies.
  • They summarize the results to produce a picture of the body of evidence available. 
  • They are systematic because they search for and analyze evidence in a systematic way, according to predetermined and published methods.

Intervention reviews

Intervention reviews seek to answer questions about the effectiveness of healthcare interventions (medicines, treatments or policies) on the people who receive them. For example: ‘How effective is acupuncture for treating depression’; or ‘Which treatment is most effective for treating psoriasis?’. To answer such questions, the authors of intervention reviews identify studies that compare one intervention with either another intervention, an inactive intervention (placebo), or no intervention. Depending on the number and reliability of the studies identified, intervention reviews may provide information on whether the intervention works, or whether we need more evidence before we can draw a conclusion. They may identify for whom the intervention works best, which version of the treatment works best, whether another option is just as effective, and whether it causes any unwanted effects. 

DTA reviews

DTA reviews evaluate how well diagnostic tests (index tests) identify or exclude a particular disease or condition (the target condition). We know that diagnostic tests make errors, even when they are correctly performed. There are two types of test errors: false positive test errors (the index test suggests the target condition is present when it is not) and false negative test errors (the test suggests the target condition is absent when it is not). Cochrane DTA reviews can cover all types of diagnostic tests, from antibody tests to X-rays, for any disease or condition. It is really important that diagnostic tests provide accurate results so that people can receive prompt treatment or take preventive measures if necessary, and to avoid unnecessary testing, treatment and anxiety

DTA reviews combine the results of all available test accuracy studies to determine the best possible estimate of the accuracy of an index test. Test accuracy studies most often report accuracy using sensitivity and specificity. 

Sensitivity means the proportion of people who are correctly diagnosed by the index test. Specificity means the proportion of people without the target condition who are correctly identified by the index test. Therefore, the nearer the sensitivity and specificity are to 100%, the better the test.

An alternative way to report test accuracy is using positive and negative predictive values, which tell us about the usefulness of a positive index test result and a negative index test respectively – this helps patients understand how reliable their test results are. Predictive values measure the number of positive index test results that will be true positives and the number of negative index test results that will be true negatives. The nearer the positive and negative predictive values are to 100%, the better the test. 

Cochrane DTA reviews are concerned with evaluating test accuracy. A new test may benefit patients because it offers an improvement in accuracy compared to existing tests. Alternatively, a new test may have similar accuracy to existing tests but with the advantage of being quicker, cheaper or easier to perform so that tests are available to more patients and results are obtained more quickly.

Learn more:

Tuesday, June 23, 2020

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