Cochrane has released a new Special Collection Coronavirus (COVID-19): evidence relevant to clinical rehabilitation. This Special Collection is one of a series of collections on COVID-19, and will be regularly updated.
Rehabilitation has been identified by the World Health Organization (WHO) as an essential health strategy, alongside promotion, prevention, treatment, and palliative care. Rehabilitation focuses on the overall functioning of the whole person, including comorbidities. Consequently, rehabilitation of individuals who have experienced COVID-19 must consider not only the consequences of the disease but also the effects of treatments applied during the acute phase. Rehabilitation inherently serves to reduce disability, with broad health, social, and economic impacts.
This Special Collection is the result of collaboration within Cochrane Rehabilitation, with rigorous involvement from stakeholders: the Steering Committee of the REH-COVER (Rehabilitation COVID-19 Evidence-based Response) action and the Cochrane Rehabilitation Advisory Board. This Special Collection includes systematic reviews from Cochrane Emergency and Critical Care, Cochrane Neuromuscular, Cochrane Pain, Palliative and Supportive Care and Cochrane Common Mental Disorders.
Image credit: Montecatone Rehabilitation InstituteWednesday, October 21, 2020
Cochrane Rehabilitation has received an award from AMLAR (America Latina Physical and Rehabilitation Medicine Association) and the University of Antioquia's Evidence Based Medicine Group for blogshot translations in Spanish.
Cochrane Rehabilitation, one of 13 Cochrane Fields, has been producing blogshots for all new Cochrane Reviews published in the past couple of years and relevant to the rehabilitation medicine field. Chiara Arienti started this initiative after her training in Oxford based on the model used by Cochrane UK; some evolution has occurred with the Field's experience with the project, but the overall project is true to Cochrane UK's model.
Typically, Cochrane Rehabilitation produces 2 to 4 blogshots per months that are then published in the Cochrane Rehabilitation Newsletter with an accompanying text giving more details on the review and commenting on it from a rehab perspective. This is all coordinated by Cochrane Rehab's Comunication Working area led by Francesca Gimigliano, according to our Comunication Strategy.
The translations into Spanish are provided according to the agreement made with the University of Antioquia, by the group coordinated by Luz Helena Lugo-Agudelo, who is also member of Cochrane Rehabilitation's Advisory Committee.
Congratulations to Cochrane Rehabilitation!
Cochrane Crowd is pleased to launch its latest citizen science task: COVID Quest. We need your help to find studies related to COVID-19. Anyone can join this task. To join, simply head over to Cochrane Crowd and once logged in, you will see the task in your task dashboard.
The task is supported by an interactive training module that will guide you through the different types of studies we are looking for.
The studies identified by the Crowd will be fed to Cochrane’s COVID-19 register of studies. This register is fast becoming an essential source of studies for systematic reviewers and others around the world.
Anna Noel-Storr, who manages the Cochrane Crowd platform, says:
“This new task in Cochrane Crowd is exciting for us because it’s quite different from other tasks. The Crowd are presented with a title and abstract of a research article and they have to answer a series of questions about it relating to the study design and the aim of the study.
It is one of our more challenging tasks but there is a good training module. It’s a great way to learn a bit about different types of studies while at the same time contribute to the global effort to defeat COVID-19”.
How to participate in COVID Quest:
- Go to crowd.cochrane.org and sign-up/log-in
- Head to your tasks page and you will see a task called COVID Quest
- Click the training button to launch the training module
It is anticipated that this task will be live on Cochrane Crowd for the foreseeable future. Our current COVID Quest records are from Embase.com and provided under license from Elsevier.
Join Cochrane’s Editor in Chief and Dr. John Grove of WHO for a World Evidence Based Healthcare Day panel session
We are delighted to announce that as part of the inaugural World Evidence Based Healthcare Day on Tuesday 20 October, Cochrane will host an online session with Dr. John Grove, Director of the Quality Assurance, Norms and Standards Department within the World Health Organization (WHO) Science Division.
During the session, COVID-19: evidence challenges and lessons learned, Cochrane Editor in Chief Dr. Karla Soares-Weiser and Dr. Grove will discuss WHO’s evidence needs during the COVID-19 pandemic, Cochrane’s response to support those needs, and to reflect on evidence priorities during the next phase of the pandemic.
Cochrane is a non-governmental organization (NGO) in official relations with WHO. During the COVID-19 pandemic, we have been working closely with WHO by producing rapid reviews to answer priority questions, thus supporting the development of effective guidance, treatments and cost-efficient responses to the pandemic.
The session is open to all who are interested. A link to join the session will be provided Monday 19 October.
Infertility affects as many as 1 in 7 couples. Many of these people turn to fertility treatments for help. In vitro fertilisation (IVF) is generally considered the most advanced treatment option, and is recommended in many cases, regardless of the cause of subfertility.
Currently there are many adjunctive treatments offered in addition to standard IVF, in the hope that pregnancy outcomes will improve. These have been called IVF ‘add-ons’. The term has gained popularity and is applied to collectively group any extra (non-essential) procedures, techniques or medicines, which can be added to standard IVF protocols, and which often claim to increase the chance of a successful outcome. IVF add-ons also tend to cost extra, on top of the cost of standard IVF. Examples include endometrial scratching, assisted hatching of embryos, steroid treatments, and pre-implantation genetic testing of embryos.
The Special Collection In vitro fertilisation - effectiveness of add-ons includes Cochrane reviews assessing available evidence for specific IVF add-ons. This Special Collection aims to summarise these reviews to support health professionals and people undergoing IVF, to make decisions about offering or using IVF add-ons. The reviews in this collection should also guide future research by identifying gaps in evidence and under-researched areas. The special collection contains 11 reviews published by Cochrane Gynaecology and Fertility Group. We have only included reviews which have been published or updated in the last 5 years, to ensure the evidence is up-to-date. This means some reviews about common IVF add-ons may not have been included. When relevant reviews on add-ons become available, we will update the special collection.
Dr Sarah Lensen who developed the collection together with Cochrane Gynaacology and Fertility group adds “This Special Collection is a summary of the most robust, high-quality evidence available for different IVF add-ons. I hope that it will be useful for health professionals and people undergoing IVF, when making decisions about offering or using IVF add-ons.”
- Access the special collection In vitro fertilisation – effectiveness of add-ons for free on the Cochrane library
- Read the Evidently Cochrane blogpost 'IVF add-ons: the latest Cochrane evidence'
- Visit the Cochrane Gynaecology and Fertility website
Featured Review: Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta-analysis
Which medicines work best to stop people from being sick (vomiting) after an operation?
Why are people sick after an operation?
Feeling sick (nausea) or being sick (vomiting) is a common unwanted effect of general anaesthesia—medicine that makes people unconscious and unresponsive so they don't move or feel pain during an operation.
Most unwanted effects of general anaesthesia, including feeling or being sick, happen immediately and stop after a few hours, although some people may continue to feel sick for up to a day. If people carry on feeling or being sick, they might have to stay in hospital longer than expected and may experience other unwanted effects or complications.
Women are more likely to be sick after an operation, as are people taking opioid painkillers, those who have had motion sickness, and those who have been sick after previous operations.
Medicines to stop people from being sick
Medicines called antiemetics are given to stop people from feeling or being sick. For people at higher risk of being sick, these medicines may be given before or during anaesthesia.
Antiemetic medicines are grouped into six classes based on how they act. Combining medicines from different classes sometimes makes them work better.
Why we did this Cochrane Review
We wanted to find out which medicines work best to stop people from being sick after an operation and cause the fewest unwanted effects. Common unwanted effects of antiemetic medicines include headache, constipation, movement disorders such as tremors, sleepiness, irregular heartbeat, and wound infection.
What did the authors do?
The authors of this review searched for studies that looked at the use of antiemetic medicines in adults having general anaesthesia to stop people from being sick afterwards.
They looked for randomised controlled studies, in which the treatments people received were decided at random. This type of study usually gives the most reliable evidence about the effects of a treatment.
Authors included evidence published up to November 2017; in April 2020, we found another 39 studies, which are not yet included in the analysis.
What they found
The authors found 585 studies in 97,516 people (83% women) who were given antiemetic medicines before or during general anaesthesia. Most studies were conducted in Asia, Europe, or North America.
These studies measured how many people were sick in the first 24 hours after their operation and how many unwanted effects were reported. Most studies compared medicines (given alone or in combination) with a dummy (placebo) treatment.
Authors compared all antiemetic medicines with each other using a mathematical method called network meta-analysis.
What were the main results and how reliable are these results?
Compared with placebo treatment, 10 out of 28 single medicines and 29 out of 36 combinations of medicines stopped people from being sick in the first 24 hours after their operation (282 studies). Combinations of antiemetic medicines generally worked better than single medicines given alone. However, aprepitant, casopitant, and fosaprepitant worked as well alone as most combinations of antiemetics. The single medicine that worked best was fosaprepitant, followed by casopitant, aprepitant, ramosetron, granisetron, dexamethasone, tropisetron, ondansetron, dolasetron, and droperidol.
The authors of this review are confident that aprepitant, ramosetron, granisetron, dexamethasone, and ondansetron stopped people from being sick. They are moderately confident about how well fosaprepitant and droperidol worked, but this finding may change when further evidence becomes available. They are uncertain about how well casopitant, tropisetron, and dolasetron worked.
Not all studies reported serious, life-threatening unwanted effects. The review authors are uncertain how many of these effects were reported when taking an antiemetic medicine and whether serious, life-threatening unwanted effects occur at a similar rate or are reduced compared to placebo (28 studies).
Of the best medicines for stopping being sick, granisetron and ondansetron probably made little to no difference in the occurrence of unwanted effects compared to placebo, although dexamethasone and droperidol may cause fewer unwanted effects than placebo. Authors are uncertain about unwanted effects with aprepitant and ramosetron (61 studies). They found no studies reporting unwanted effects for fosaprepitant.
Authors are less confident about unwanted effects of all other antiemetic medicines because they found little reliable evidence about this. The results for unwanted effects are likely to change when further evidence is available.
For people at higher risk, some medicines worked well to stop them from being sick after general anaesthesia. The most reliable antiemetic medicines were aprepitant, ramosetron, granisetron, dexamethasone, and ondansetron, followed by fosaprepitant and droperidol.
However, the authors did not find enough reliable evidence about potential unwanted effects to rank these medicines reliably according to how well they worked.
Cochrane is in the final year of its multi-year strategic plan, Strategy to 2020.
Strategy to 2020 has set in motion transformational change in the way Cochrane works at all levels of the organization with the aim of giving us the best chance to achieve our mission. Goal 4 of Strategy to 2020 challenged us to be a diverse, inclusive, and transparent international organization that effectively harnesses the enthusiasm and skills of our contributors, is guided by our principles, governed accountably, managed efficiently, and makes optimal use of its resources.
Watch the video below to learn about Cochrane’s initiatives over the past several years to become a more effective, collaborative and sustainable international organization:
We are now developing a new strategy for 2021 onwards, and we want to hear from you! The draft plan is available for your review and comment, with your feedback having the potential to directly contribute to changes before it’s finalized. The deadline for your feedback has been extended and the survey will close on October 18, 2020. Let’s collaborate now to define Cochrane’s new strategic priorities!
Updated Cochrane Review shows electronic cigarettes can help people quit smoking, but more evidence is needed on long-term harms
Newly updated Cochrane evidence published today in the Cochrane Library finds that electronic cigarettes containing nicotine could increase the number of people who stop smoking compared to nicotine replacement therapy – such as chewing gum and patches – and compared to no treatment, or electronic cigarettes without nicotine. More information is needed on harms.
Smoking is a significant global health problem. Many people who smoke want to quit, but find it difficult to succeed in the long term. One of the most effective and widely used strategies to help people to give up smoking is to combat the cravings associated with nicotine addiction by delivering nicotine through patches and chewing gum.
Electronic cigarettes have been around in some form for a number of years, but recently their popularity has increased significantly, and they have begun to look and feel less like conventional cigarettes. Unlike chewing gum and patches, they mimic the experience of cigarette smoking because they are hand-held and generate a smoke-like vapour when used. This helps to recreate sensations similar to smoking without exposing users or other people to the smoke from conventional cigarettes, and can be used to provide people who smoke with nicotine.
A team of researchers have updated a Cochrane Review that compares the effects of electronic cigarettes with other ways of delivering nicotine – such as patches and chewing gum – or with dummy electronic cigarettes that do not contain nicotine or no treatment. This updated review now includes 50 studies, an increase of 35 studies since it was last published in 2016. Twenty-four of these are uncontrolled studies, but their results support the data from the randomised controlled trials. The researchers identified three studies, in 1498 people, that compared nicotine-containing electronic cigarettes with nicotine replacement therapy given as patches or gum.
The results showed that more people quit smoking if they used electronic cigarettes containing nicotine than if they used another form of nicotine replacement. If six people in 100 quit by using nicotine replacement therapy, 10 people in 100 would quit by using electronic cigarettes containing nicotine. This means an additional four people in 100 could potentially quit smoking with nicotine containing electronic cigarettes.
Similar results were seen in another three studies, involving 802 people, that compared nicotine-containing electronic cigarettes with electronic cigarettes that did not contain nicotine. Evidence from four studies (2312 people) showed that more people who used nicotine-containing electronic cigarettes quit smoking than those who received only behavioural support or no support. If four people in 100 quit with no support, an additional six people in 100 might quit by using nicotine electronic cigarettes. The review authors did not detect any clear evidence of serious harms from nicotine electronic cigarettes. However, evidence about serious harms is uncertain because the overall number of studies was small and serious health problems were very rare in both users and non-users of nicotine electronic cigarettes.
There was no information about the effects of long-term use (more than two years) of nicotine-containing electronic cigarettes. The studies showed that throat and mouth irritation, headache, cough, and nausea are the most commonly reported side effects in the short- to medium-term (up to two years). The studies assessed the potential harms of electronic cigarettes when used to help people who smoke quit smoking, so did not assess other potential harms such as whether electronic cigarettes encourage nicotine use among people who do not smoke.
The lead author of this updated Cochrane Review, Jamie Hartmann-Boyce from the Cochrane Tobacco Addiction Group, said, “The randomised evidence on smoking cessation has increased since the last version of the review and there is now evidence that electronic cigarettes with nicotine are likely to increase the chances of quitting successfully compared to nicotine gum or patches. Electronic cigarettes are an evolving technology. Modern electronic cigarette products have better nicotine delivery than the early devices that were tested in the trials we found, and more studies are needed to confirm whether quit rates are affected by the type of electronic cigarettes being used. While there is currently no clear evidence of any serious side effects, there is considerable uncertainty about the harms of electronic cigarettes and longer-term data are needed. Scientific consensus holds that electronic cigarettes are considerably less harmful than traditional cigarettes, but not risk-free. We are encouraged to see that 20 trials are now underway, and we will be looking for newly published evidence every month from December 2020. It is important that the review continues to provide up-to-date information to people who smoke, healthcare providers and regulators about the potential benefits and harms of electronic cigarettes.”
Featured Review: Do measures that aim to reduce aerosol production during dental procedures prevent the transmission of infectious diseases?
Why is this question important?
Most dental care procedures create tiny drops of liquid that float in the air, called aerosols. For example, to remove the film of bacteria (plaque) that builds on teeth, dentists use scaling machines (scalers). Scalers vibrate at high speed and use a flow of water to wash away the plaque. This produces aerosols that are made of air, water, and the patient’s saliva, which may also contain micro‐organisms such as bacteria, fungi and viruses.
Aerosols that contain bacteria, fungi or viruses can spread infectious diseases. Limiting the production of these aerosols could help to prevent disease transmission in a dental setting.
A range of approaches can be used to reduce production of potentially infectious aerosols during dental procedures. These include:
- ways to decontaminate the mouth before aerosols are produced, for example by using anti‐microbial mouthwash;
- ways to prevent aerosols from leaving the mouth (for example, placing a rubber sheet – known as a ‘dam’ – around the tooth that is to be treated, to isolate the treatment zone from saliva; or using a straw‐like suction tube known as a saliva ejector);
- local ventilation using a suction device (known as a high‐volume evacuator) that draws up a large volume of air and evacuates aerosols from the treatment zone;
- general ventilation, to reduce the concentration of aerosols in the air, for example by keeping windows open;
- decontamination of air‐borne aerosols, for example using ultraviolet light to sterilize the air.
These can be used alone, or in combination.
The authors of this review analysed the evidence from research studies to find out whether interventions that aim to reduce aerosol production during dental procedures can prevent the transmission of infectious diseases. They also wanted to find out about the cost of the interventions, whether patients and dentists found them acceptable, and whether the interventions were easy to implement.
How did authors identify and evaluate the evidence?
First, they searched for all relevant studies in the medical literature that compared interventions to reduce aerosol production during dental procedures against other interventions or no intervention. Authors then compared the results, and summarized the evidence from all the studies. Finally, they assessed how certain the evidence was. To do this, they considered factors such as the way studies were conducted, study sizes, and consistency of findings across studies. Based on these assessments, review authors categorized the evidence as being of very low, low, moderate or high certainty.
What did they find?
They found 16 studies that involved a total of 425 people. Studies involved between one and 80 participants, who were aged between 5 and 69 years. Six studies were conducted in the USA, five in India, two in the UK and one each in Egypt, the Netherlands and the United Arab Emirates.
The studies evaluated one or more of the following devices:
- high‐volume evacuator (7 studies);
- hands‐free suction device (2 studies);
- saliva ejector (1 study);
- rubber dam (3 studies);
- rubber dam with a high‐volume evacuator (1 study); or
- air cleaning system (1 study).
None of the studies evaluated the risk infectious disease transmission. Nor did they evaluate cost, acceptability or ease of implementation.
All 16 studies measured changes in the levels of bacterial contamination in aerosols, but the review authors assessed the evidence as being of very low certainty. This means that there is very little confidence in the evidence, and that the authors expect further research to change the findings of this review. Authors therefore cannot deduce from this evidence whether there is an effect on levels of bacterial contamination. No studies investigated viral or fungal contamination.
What does this mean?
We do not know whether interventions that aim to reduce aerosol production during dental procedures prevent the transmission of infectious diseases. This review highlights the need for more and better‐quality studies in this area.
How up to date is this review?
The evidence in this Cochrane Review is current to September 2020.
Specifications: Permanent, Full time
Location: UK/Europe (flexible location considered)
Application Closing Date: 29 October 2020
Do you have a drive to make a difference for health care world-wide? We are a global, independent organization that strives to inform health-care decisions every day. We gather and summarize the best evidence from research to help doctors, nurses, patients, carers, researchers, funders, and policymakers. We do not accept commercial or conflicted funding, and work to minimize risk of bias, in order to generate authoritative and reliable information.
As our Cochrane Response Managing Director you will be leading and managing Cochrane’s evidence consultancy unit, Cochrane Response. Cochrane Response provides a broad range of literature review and evidence synthesis services to international policy makers and guideline developers to support evidence informed healthcare decision making.
There are three key elements to the role:
- Managing and running an evidence consultancy business unit.
- Managing the team of systematic reviewers and their work in review production, including the technical expertise this requires.
- Networking and engaging with internal and external stakeholders to grow Cochrane Response and find new global commissioners and research funding opportunities.
How to apply
- For further information on the role and how to apply, please click here
- The deadline to receive your application is by 29th October 2020
- The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples. Note that we will assess applications as they are received, and therefore may fill the post before the deadline
When residency education was disrupted by the COVID-19 pandemic, the Emory University School of Medicine capitalized on student enthusiasm and availability to create COVID-19 education materials. Working closely with Cochrane, they are now summarizing top priority COVID-19 rapid reviews in visual form.
The project, known as the “COVID-19 Visual Series,” involves students being alerted when a high-profile Cochrane review is being published and then working in teams to create accurate, easy-to-read visual abstracts. These visuals are then published on Cochrane.org along with the review Plain Language Summary and news item. To ensure the accuracy of the disseminated information, a fellow or faculty member reviews all infographic content and provides feedback to the students. As a final check to ensure accuracy, a senior member of the Cochrane Editorial team or Cochrane author reviews the final content before publication.
As the pandemic has escalated, what had begun as an experiment, has evolved into an online publishing operation involving over 100 Emory medical students, a large group of infectious disease fellows, and several professors and editors. Participants earn Cochrane Membership points for their contributions; as Cochrane Members they can print out certificates and add officially to their CVs. They are also noted on each visual created and tagged on social media to give full credit.
Dr. Caroline Coleman, the editor-in-chief of the project, says, “This has been a really rewarding experience for Emory students. They are diving deep into the Cochrane systematic review and really getting a good understanding of the evidence and conclusions to be able to explain it fully in plain language and in a way that is also visually appealing. Cochrane was something that Emory students learnt about in the classroom --now they are actively involved in improving the understanding of Cochrane evidence.”
Karla Soares-Weiser, Cochrane Library Editor in Chief, commented, ‘The visual abstracts created by the Emory students are high quality and help improve the understanding of Cochrane evidence. The way these have been produced highlights the innovation and teamwork that underscores all of our COVID-19 work. We are pleased to see these visuals being shared widely on social media and the students getting the credit they very much deserve.”Cochrane-specific visual abstracts Digital contact tracing technologies in epidemics: a rapid review
Carlyn Harris @carlynharris - 2nd year, MD Program
"I loved the opportunity to collaborate both with my colleagues at Emory as well as faculty at Cochrane while learning about the effect of public health measures for COVID19. We learn more about this disease everyday; it was a privilege to deliver such important messages in an accessible format."
Emilie Morris @morris_emiliec - 3rd year, MD program
"I believe it is incredibly important, now more than ever, to have digestible health and science content to deliver to our patients, providers, and governments. The sheer volume of information can be easily overwhelming, and it is a delight to exercise my creative side in helping remove barriers to a better understanding of COVID-19 research."
Tyler Daugherty @tylerdau - 4th year, MD program
“Loved the opportunity to convey important science in an efficient way and contribute to the COVID effort. It’s a fun challenge to take the complex work of scientific studies and intuitively show it. Efficient dissemination of scientific information so that it can be used is always important, but even more so during COVID where providers are more busy and information is rapidly evolving.”
Carey Jansen @careyjans - 6th year, MD/PhD Program
"Composing visual abstracts has been a fantastic way to interact with the COVID-19 literature, as well as hone my writing and design skills, all while getting to collaborate with other medical students, residents, and faculty."
<visual abstract coming soon!>
Namita Mathew @nemathew - 3rd year, MD program
"Being involved with the visual abstract project has encouraged me to stay updated on the constantly evolving research on COVID-19 while getting the chance to collaborate with peers. Brainstorming creative ways to visually communicate high-impact research to larger audiences has been a rewarding process."
Anna Zimmer @Anna__Zimmer - MA in Bioethics student, M4
"Communicating scientific evidence is challenging and critical. Creating visual abstracts with my colleagues has been one way to actively participate in improving this communication. As someone who hopes to continue to make science widely accessible (and exciting!), I am really thrilled to be part of this project."
<Visual abstract coming soon!>
Rachel Fried @RachelFried6 - 3rd year, MD program
"Creating visual abstracts has been an extremely rewarding creative outlet during these unprecedented times. It has allowed me to stay up to date on the current COVID-19 research, an opportunity to support the healthcare community in an accessible format, as well as collaborate and learn alongside my talented classmates and colleagues."
<visual abstract coming soon!>
Angel Xiao @an_xiao_ - 3rd year, MD program
"As someone who has always been passionate about the intersection of design principles and medical education, I feel incredibly grateful to have worked alongside my peers to help disseminate high-impact research through the COVID-19 visual abstract series, and I am excited about the implications of this project on furthering scientific engagement and literacy."
<visual abstract coming soon!>
Emerson Bouldin @em_bouldin 3rd year, MD program
"Creating visual abstracts for high-impact COVID-19 research has allowed me to support healthcare professionals in a unique way during the pandemic and provided rewarding opportunities for creative collaboration with classmates, colleagues, and the larger scientific community."
Featured Review: Do psychological and social interventions prevent mental health disorders in low‐ and middle‐income countries affected by humanitarian crises?
Mental health disorders are among the leading contributors to all years lived with disability. Prevention strategies offer new possibilities to reduce their disease burden, given that many risk factors for mental health conditions have social and/or environmental roots, such as gender-based violence, poverty, unemployment, social marginalization, and lack of education. This is especially true for people living in low- and middle-income countries affected by armed conflicts and social catastrophes triggered by inauspicious events.
Most of the consequences of humanitarian crises on mental health ranges from transient acute stress reactions, to chronic subthreshold distress manifestations, to the establishment of a full-blown mental disorders. Interventions focused on prevention of mental health disorders usually target modifiable causal factors that contribute to the development of psychological symptoms. Specifically, prevention 'psychosocial' interventions are aimed at decreasing risk factors for the development of mental disorders or at building resilience and increasing a sense of hope and safety to protect against psychological symptom development
In this review the researchers of the Cochrane Global Mental Health (CGMH) network, asked whether psychosocial interventions were efficacious in preventing the onset of mental disorders in people living in LMICs affected by humanitarian crises. To be included in the review, participants did not have to be diagnosed with a mental health disorder at the beginning of the trial.
Is there enough evidence to draw conclusions on the matter?
The review included only seven studies, and none of them measured the primary outcome, as it was conceived by the study authors in the review protocol: changes in the incidence of disorders from baseline to trial endpoint. Instead, the studies measured symptoms of depression, anxiety and post-traumatic stress disorder in children and adolescents, and anxiety and depression symptoms in adults, at the beginning of the study, the end of the intervention, after four weeks and up to four months later.
Psychosocial interventions weren’t found to be more effective than comparator “waiting list” in the short term and medium term. However, these results were imprecise due to lack of data, thus it is possible that the play of chance had a role in distorting results. Furthermore, study populations were heterogeneous, as all but two of the included trials were conducted in different countries of the world and enrolled participants were exposed to different sources of distress. A more thorough picture of the evidence will be outlined by future studies. The authors list some recommendations for researchers that could be of help in the designing and conducting of future trials.
Future directions for Cochrane Common Mental Disorders
It is important that we learn more about the “why”, “how”, and “for whom” prevention psychosocial interventions work, for both adult and juvenile populations. Cochrane Common Mental Disorders is committed to the prioritization of global mental health issues, and actively working in this direction. A further review is ongoing, assessing the evidence on psychosocial interventions for the promotion of mental health conditions such depression, PTSD or anxiety, in the same setting considered for the present review. This project is being implemented at the CGMH, based in Verona - Italy, in collaboration with Cochrane Evidence Practice and Organization of Care.
- Read the full Cochrane Review
- Visit the Cochrane Global Health website
- Visit the Cochrane Common Mental Disorders website
Monday, October 5, 2020
Today Cochrane launches new guidance to help people select images to share alongside Cochrane evidence. You can read more in ‘Choosing images for sharing evidence: new guidance from Cochrane'
Knowledge Translation (KT) in Cochrane is pleased to announce the launch of ‘Choosing images for sharing evidence: a guide’ - a new resource developed by Cochrane UK for people choosing images when sharing Cochrane evidence or news.
Images really matter. They are a vital part of telling the story we want to tell when we share evidence. Images can help our target audience to see that content is relevant to them and to make an immediate connection with the topic. Thoughtful image choice can inform or misinform, attract or repel, and they can help challenge assumptions and change the conversation about health conditions. The images we choose also have the potential to reinforce the message that Cochrane is a trustworthy source of reliable information to support health decisions and to encourage people to engage with the evidence.
An early lesson for Sarah Chapman, who has co-authored the guide along with Selena Ryan-Vig, was her choice of image to accompany evidence on weight loss: a warm, positive image of parents with an overweight teenager, the three sitting together and smiling. A reader told her it was such a contrast to negative images which often accompany stories about obesity and was key to them feeling able to share the article with their son.
So while choosing images is a daily task for many working within Cochrane, particularly those involved with dissemination, we should never underestimate their impact, or the challenges!
To support those selecting images, Cochrane UK has developed ‘Choosing images for sharing evidence: a guide’.
The guidance is based on, and complements, Cochrane’s Checklist and Guidance for disseminating findings from Cochrane intervention reviews. It has been tested with a diverse group of people and is applicable to materials in different languages and ¬¬cultural settings. It features a 15-item checklist and accompanying guidance with many examples of images that may work well, as well as those to avoid, with detailed explanations.
The guide also includes:
- a list of sources of images, many of which are healthcare specific and free to use
- technical advice to ensure that appropriate permission is sought, credit is given, and to make sure that images are high quality rather than fuzzy
- advice on making images accessible to people with impairments, through the addition of alt-text
- worked examples of choosing images which illustrate a range of challenges and considerations where the choice is not straightforward.
Featured Review: Do blood thinners prevent people who are hospitalised with COVID-19 from developing blood clots?
COVID-19 typically affects the lungs and airways, however, in addition to respiratory problems, about 16% of people hospitalised with COVID-19 experience problems with their blood and blood vessels, leading to blood clots forming in the arteries, vein and lungs. These blood clots can break loose and travel to other parts of the body, where they may cause blockages leading to heart attacks or strokes. Nearly half of all people with severe COVID-19, in intensive care units, may develop clots in their veins or arteries.
What are blood thinners?
Blood thinners are medicines that prevent harmful blood clots from forming. However, they may cause unwanted effects such as bleeding. Some guidelines recommend giving blood thinners when people are first admitted to hospital with COVID-19, to prevent blood clots from developing, rather than waiting to see if blood clots develop and then treating them with blood thinners.
What were the review questions?
A team of Cochrane authors wanted to know whether giving people hospitalised with COVID-19 blood thinners as a preventive measure, reduced the number of deaths compared to people who received no treatment or who received a placebo treatment. They also wanted to know whether these people needed less support with breathing, whether they still developed harmful blood clots, whether they experienced bleeding and whether they experienced any other unwanted events (for example, nausea, vomiting, kidney problems and amputations).
What were the methods?
They searched for studies that assessed blood thinners given to people hospitalised with COVID-19 to prevent blood clots. Studies could be of any design as long as they compared a blood thinner with another blood thinner, no treatment or a placebo (sham). Studies could take place anywhere in the world and participants could be any age as long as they were in hospital with confirmed COVID-19 disease. The search was completed on 20 June 2020.
What did they find?
The authors hoped to find randomised controlled trials (RCTs). RCTs allocate participants at random to receive either the treatment under investigation or the comparison treatment (another treatment, no treatment or placebo). RCTs give the best evidence.
They did not find any RCTs, so they included seven non-randomised ‘retrospective’ studies that looked back at treatments given to 5929 people. These studies took place in intensive care units, hospital wards and emergency departments in China, Italy, Spain and the USA. They provided evidence on deaths and bleeding but no evidence on respiratory support, blood clotting and other unwanted effects. The studies were very different from each other, so we were not able to pool their results.
Blood thinners compared with no treatment (6 studies)
- One study reported a reduction in mortality and another study reported a reduction in mortality in severely ill people only. Three studies reported no difference in mortality and the remaining study reported no deaths in either group.
- One study reported major bleeding in 3% of participants who received blood thinners and 1.9% of participants who did not receive blood thinners.
Treatment dose of blood thinners compared with preventive dose (1 study)
All the participants were in the intensive care unit on mechanical ventilators. They may or may not have had blood clots but were given either blood thinners in a dose usually used to treat clots (higher dose), or a dose used to prevent clots (lower dose).
- This study reported a lower rate of death in people who received the treatment dose (34.2%) compared with the preventive dose (53%).
- This study reported major bleeding in 31.7% of participants who received the treatment dose compared with 20.5% of those who received the preventive dose.
How reliable is this evidence?
We do not know whether blood thinners are a useful preventive treatment for people with COVID-19 because we are very uncertain about the evidence. None of the studies randomised participants and all were retrospective. Also, they reported different results from each other and did not report their methods fully. This means our confidence (certainty) in the evidence is very low.
What happens next?
The searches found 22 ongoing studies, 20 of which are RCTs, with 14,730 people. Ronald Flumignan, MD, PhD from the Department of Surgery, Division of Vascular and Endovascular Surgery at the Universidade Federal de São Paulo in São Paulo, Brazil and lead author of this Cochrane Review says, "At the moment we are not sure whether this treatment may help prevent the dangerous clotting we see in some COVID-19 patients, but we identified several ongoing studies. We will update our review as new results from these studies become available, and in time we hope we will be able to answer this important question.”
Cochrane is in the final year of its multi-year strategic plan, Strategy to 2020.
Strategy to 2020 has set in motion transformational change in the way Cochrane works at all levels of the organization with the aim of giving us the best chance to achieve our mission. Goal 3 of Strategy to 2020 challenged us to make Cochrane the ‘home of evidence' to inform health decision making, build greater recognition of our work, and become the leading advocate for evidence-informed health care.
Watch the video below to learn about Cochrane’s partnership and advocacy activities during the past several years:
We are now developing a new strategy for 2021 onwards, and we want to hear from you! The draft plan is available for your review and comment, with your feedback having the potential to directly contribute to changes before it’s finalized. Let’s collaborate to define Cochrane’s new strategic priorities.
How effective is hospital-based specialist palliative care for adults with a terminal illness and their unpaid caregivers, and is it cost-effective?
Why is this question important?
Palliative care aims to improve the quality of life of people who have a terminal illness (a disease that cannot be cured and is likely to lead to death). It seeks to help patients, their unpaid caregivers and families manage symptoms that cause distress (for example, pain) and to meet patients’ and unpaid caregivers’ needs for psychological, social and spiritual support. Palliative care is known as an ‘holistic’ approach, because it considers the ‘whole’ person and their support network – not just the illness and its symptoms. It usually involves a team of people that can include physicians, nurses, pharmacists, other allied health professionals, social workers, chaplains or volunteers.
A growing number of hospitals are setting up specialist palliative care services (known as hospital-based specialist palliative care (HSPC)). HSPC can be provided:
- either in the hospital itself – for inpatients or outpatients;
- or as 'hospital-at-home' – which means that the hospital team visits patients in the community;
- or across multiple settings (for example, hospital and home).
To find out whether HSPC benefits patients and their unpaid caregivers, and how cost-effective it is, the author team reviewed the evidence from research.
How did the authors identify and evaluate the evidence?
First, they searched for all relevant studies in the medical literature. They specifically looked for:
- randomised controlled studies: these are studies where people are randomly divided into different treatment groups. This type of study provides the most robust evidence about the effects of a treatment;
- studies that compared HSPC to either hospital care without specialist palliative care; care received in the community; or hospice care outside hospital.
The review authors then compared the results, and summarised the evidence from all the studies. Finally, they assessed how certain the evidence was. They considered factors such as the way studies were conducted, study sizes, and consistency of findings across studies. Based on the assessments of the author team, they categorised the evidence as being of very low, low, moderate or high certainty.
What did authors find?
42 studies that involved a total of 6678 patients and 1101 caregivers or family members.
The evidence from the studies found suggests that, when compared to usual care:
- HSPC may slightly improve patients’ health-related quality of life, their overall symptom burden and their satisfaction with care;
- HSPC may increase the chances of people dying in their preferred place of death.
It is unclear what the effects of HSPC are on pain, caregivers’ burden, or unwanted events. This is because the evidence found was not robust (very low-certainty evidence). Similarly, because the evidence relating to costs was of very low certainty, it is unclear how cost-effective HSPC is.
What does this mean?
When compared with usual care, HSPC may slightly improve a patient’s quality of life, symptom burden and their satisfaction with care. It may also increase their chances of dying at home. However, future research is likely to change these findings, since they are based on low-certainty evidence. Further studies are needed to evaluate the effect of HSPC on other outcomes, such as pain, caregivers’ burden, unwanted events and cost-effectiveness.
How-up-to date is this review?
The evidence in this Cochrane Review is current to August 2019.
Discussing the review, Dr. Sabrina Bajwah, Clinical Senior Lecturer, King’s College London and first author of this review, explains, "Population-based projections have indicated that palliative care needs will increase in the future. Whilst we should interpret the results with caution, our systematic review provides clinicians, policy makers and funders with some clarity on the benefits of hospital palliative care. This may help make informed decisions when looking to prioritise further commissioning of hospital-based specialist palliative care. It also provides patients and their care givers valuable information to inform treatment choices on how hospital palliative care may be able to help improve patient centred care and increase the chances of dying in their preferred place, which is often at home. The provision of palliative care is an ethical imperative for those unlikely to survive and may have the advantage of diverting dying people away from overburdened hospitals as well as providing the care that people want. These benefits may be especially clinically relevant during pandemics and at an advanced stage of disease."
Generating a culture of evidence means creating an environment in which evidence is always an important part of health-care decision making; it's valued, understood, and used.
In a culture of evidence, Cochrane can and does have an impact beyond the world of research. We work closely with our partners to focus our work on the most important questions for decision makers, involve external partners in creating evidence, disseminate evidence in formats decision makers can understand, and advocate for using evidence for informing policy and decision making.
Learn more about what is a culture of evidence and how Cochrane can support it:
How accurate is chest imaging for diagnosing COVID-19?
Why is this question important?
People with suspected COVID-19 need to know quickly whether they are infected, so that they can self-isolate, receive treatment, and inform close contacts. Currently, formal diagnosis of COVID-19 infection requires laboratory analysis of blood or nose and throat samples. The laboratory test, called RT-PCR, requires specialist equipment and takes at least 24 hours to produce a result. Further, RT-PCR is not completely accurate and a second RT-PCR or a different test may be required to confirm the diagnosis.
COVID-19 is a respiratory infection: people with COVID-19 may have a cough, may have difficulty breathing and in severe cases may have COVID-19 pneumonia. Clinicians use chest imaging tests to diagnose COVID-19 disease, when awaiting RT-PCR test results, for example, or when RT-PCR results are negative, and the person has COVID-19 symptoms.
The authors wanted to find out how accurate chest imaging is in diagnosing COVID-19 disease in people with known or suspected infection.
What are chest imaging tests?
X-rays or scans produce an image of the organs and structures (heart, lungs and airways) in the chest. They can detect blockages, inflammation and excess fluid.
- X-rays (radiography) use a small amount of radiation to produce a 2-D image. They are usually carried out in hospitals using fixed equipment by a radiographer but may also be carried out using a portable machine.
- Computed tomography (CT) scans use a computer to merge multiple X-ray images taken from different angles to produce a 2-D image that can be converted to a 3-D image. They require highly specialised equipment and are carried out in hospital by a specialist radiographer.
- Ultrasound scans use high-frequency sound waves to produce an image. They can be carried out in hospital or other healthcare settings such as a doctor’s surgery or clinic.
What did the authors do do?
The authors of this Review searched for studies that assessed the accuracy of chest imaging to diagnose COVID-19 disease. Studies could include people with either suspected or confirmed COVID-19, based on the results of an RT-PCR or other test. Studies could be of any design and take place anywhere.
What did they find?
The authors found 84 studies with 8279 people. Studies included either only people with confirmed COVID-19 diagnosis (71 studies, involving 6331 people) or both suspected and confirmed COVID-19 (13 studies, involving 1948 people). Infection was mainly confirmed using RT-PCR.
The majority of studies evaluated chest CT. We found studies from all over the world; 78 studies took place in Asia.
Accuracy of chest imaging for diagnosing COVID-19 in people with confirmed infection
On average, chest CT correctly identified infection in 93% of people with confirmed COVID-19 (65 studies, 5759 people). Chest X-ray correctly identified infection in 82% of people with confirmed COVID-19 (nine studies, 682 people). Lung ultrasound correctly identified infection in 100% of people with confirmed COVID-19 (2 studies, 32 people).
Accuracy of chest imaging for diagnosing COVID-19 in people with suspected or confirmed infection
On average, chest CT correctly identified infection in 86% of people who were infected with COVID-19 (13 studies, 2346 people). However, it incorrectly identified infection in 82% of people who were not infected with COVID-19. We did not find any studies that reported data on lung ultrasound.
How reliable are the results?
Studies reported limited information about how they confirmed COVID-19 diagnosis, how they recruited participants, and they did not always use robust methods. Most studies only included people with a confirmed COVID-19 diagnosis, so we have little information about the ability of chest imaging to rule out COVID-19 in people who are not infected. Also, studies did not report any pre-existing respiratory conditions that might have affected their results. Finally, 25% of studies were published as preprints, which do not undergo the same rigorous checks as published studies. The authors cannot confidently draw conclusions based on the results from studies included in this review.
What does this mean?
The evidence suggests that chest CT and chest X-ray may be good tests for confirming COVID-19 diagnosis in people who have been diagnosed with COVID-19 infection using another test. However, CT scans may be less accurate in confirming or ruling out infection in people with only suspected COVID-19.
The authors plan to update this review regularly as more research becomes available.
How up-to-date is this review?
The evidence in this Cochrane Review is current to May 2020.
COVID-19 Study Register: Cochrane’s ‘one-stop-shop’ for global researchers passes more than 20,000 references...and counting!
Cochrane COVID-19 Study Register gains support from Cochrane Crowd and Elsevier to add Embase.com records as it passes a new significant milestone - publishing 20,000 primary study references on COVID-19.
The Study Register was launched in April 2020 with the aim of supporting rapid and living evidence synthesis by systematic review producers and researchers across the world as well as Cochrane's own work on COVID-19-related Rapid Reviews, Systematic Reviews and Network Meta-Analyses. Five months on, it’s been a source of studies in twelve published Cochrane Reviews, the Australian National COVID-19 Clinical Evidence Taskforce’s living guidelines and 15 other systematic reviews on COVID-19.
It provides a ‘one-stop shop’ for researchers to access all primary studies being published related to COVID-19. Study references are pre-evaluated to meet eligibility for COVID-19 reviews, reducing searching and screening time for author teams. The Register helps systematic reviewers prioritize topics, identify available evidence and produce urgently needed reviews for front-line health professionals, public health policymakers and research teams developing new therapeutic, diagnostic and preventive interventions for COVID-19.
Since it was set up, new functionality and enhancements have been added to the Register, which now includes:
- Increased coverage with >1300 preprint records;
- Enhanced searching with new filters for publication type filters and studies reporting results;
- Automated PubMed search, which now updates daily; and
- A pilot Crowd task to screen and describe eligible studies.
In July, Elsevier and Cochrane partnered to add Embase.com records to the Cochrane COVID-19 Study Register, helping to increase the register’s coverage of MECIR mandatory databases and making the register a comprehensive source of studies for review production.
Cochrane’s Head of Information Technology, Chief Information Officer and project lead, Chris Mavergames, said: “COVID-19 continues to present a formidable challenge for global health researchers. We are pleased to report that our data curation and synthesis tools are now being using in practice to assist in rapidly addressing the most important questions for global decision-makers and our Study Register represents a key pillar in that effort. We are also pleased to announce that, following from our successful pilot Crowd task, today we have launched a new Cochrane Crowd task, COVID Quest, to help identify eligible COVID-19 studies from Embase.com.”
Cochrane has submitted a statement to the 58th Pan American Health Organization (PAHO) Directing Council.
PAHO, an international public health agency focused on the Americas, serves as a regional office for the World Health Organization (WHO). The PAHO Directing Council is a key meeting that brings together ministers of health, policymakers, technical staff and other stakeholders to decide on the health priorities for collective action in the region.
Our statement highlights how Cochrane Groups in the PAHO Region are supporting an evidence-informed COVID-19 response and calls on PAHO Member States to provide adequate resources and funding for evidence synthesis as the pandemic continues. The statement will be delivered by Xavier Bonfill, Director of Cochrane Iberoamérica.
The full statement is below.
COVID-19 has emphasized the critical importance of evidence-informed global health policy. Governments, healthcare professionals and researchers in the PAHO Region and worldwide continue to seek answers to questions related to the treatment of patients, and how best to protect populations.
Cochrane is a global leader in producing high-quality synthesized evidence to inform health decision making. We are working closely with WHO and PAHO by producing Rapid Reviews and living systematic reviews to answer COVID-19-related priority questions. Cochrane has launched and will maintain one of the largest and most sophisticated registries of COVID-19 studies and a living synthesis of COVID-19 study results.
Cochrane’s Geographic Groups in the PAHO Region are also active in supporting an evidence-informed COVID-19 response:
- Cochrane Canada, with the WHO Collaborating Centre for Infectious Diseases, Research Methods and Recommendations at McMaster University, has led WHO-commissioned rapid systematic reviews on priority topics. With funding from the Canadian Institutes of Health Research, they are also building a map of living recommendations from high-quality guidelines on COVID-19 that, for decision-makers in the region, can be contextualized. PAHO is a valued partner and contributes the base internacional de guías GRADE (BIGG) as a central source of guidelines.
- The Cochrane Iberoamerican Network has produced Evidencias COVID-19, an information resource on COVID-19 in Spanish. Cochrane Iberomérica has also integrated over 500 COVID-19 recommendations (in English and Spanish) within DianaSalud, a database containing guidance on the implementation and de-implementation of healthcare interventions based on their clinical value.
- The Cochrane US Network has developed a COVID-19 repository highlighting the work of its affiliates, including a rapid review on universal screening; affiliate-led reviews contributing to WHO guidelines on breastfeeding and hypertension during COVID-19; and the development of rapid guidelines with professional societies.
With the pandemic evolving, the questions that policy makers need to address change. We therefore call on PAHO Member States to support evidence-informed decision making by taking action to provide adequate resources and funding for evidence synthesis given the challenges ahead.Monday, September 28, 2020