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
Cochrane works with the Association for Healthcare Social Media to celebrate World Evidence Based Healthcare Day
Inaugural World Evidence Based Healthcare Day to be held on 20 October 2020
The Association for Healthcare Social Media (AHSM) is a professional society devoted to the use of social media by healthcare professionals. The multispecialty and multidisciplinary AHSM assists health professionals in utilizing social media platforms to serve as disseminators of accurate health information while doing so responsibly. AHSM members include many of the virtual physicians and nurses of TikTok, Instagram, Twitter, and YouTube who are disseminating important healthcare-related information to their audiences.
Cochrane and six global leaders in evidence-based healthcare have recently launched the inaugural World Evidence Based Healthcare (EBHC) Day, to be held on 20 October 2020. It is an opportunity to create awareness of the need for better evidence to inform healthcare policy, practice and decision making in order to improve health outcomes globally.
Working closely with Cochrane, AHSM is sharing the World EBHC Day with its members and encouraging them to participate by asking them to share posts and videos on their platforms and tag Cochrane. Austin Chiang, MD, MPH, a founding member of the AHSM and the chief medical social media officer at Jefferson Health, in Philadelphia says “World EBHC Day provides an excellent platform for our members to explain exactly what evidence based healthcare is to their audiences, why it is important, and the impact that evidence based healthcare has made. We are excited to collaborate with Cochrane; our members know them as the ‘gold standard’ in consolidating health evidence through systematic reviews and this is an opportunity to explaining to our lay audiences why that is.”
Dr. Chiang adds, “With the COVID-19 pandemic, everyone is looking for health information online. With additional time spent on social media channels, there is also greater exposure to misinformation and misrepresentation of evidence online. Our members are health professionals that are provided with the tools and training to share health evidence on social media and actively work towards fighting misinformation on social media. The COVID-19 pandemic has underscored the importance of educating our audiences about evidence based healthcare and the high quality evidence that Cochrane provides.”
Free online training module introduces the use of knowledge translation in Cochrane
Cochrane defines knowledge translation (KT) as the process of supporting the use of health evidence from our high quality, trusted Cochrane Reviews by those who need it to make health decisions. KT is an integral part of our strategy to make Cochrane evidence accessible and useful to everybody, while advocating for evidence-informed health care.
A new module, 'Introducing Knowledge Translation in Cochrane' has launched on Cochrane Training. This module aims to strengthen the understanding of what KT means within Cochrane. It presents information, examples, and stories told by characters in order to explain the concepts presented in Cochrane's KT Framework.
This learning module is aimed at anyone working within Cochrane, is free to use with a Cochrane account (free to sign up) and will take approximately 1 hour to complete.
Register now: G-I-N COVID-19 pit stop webinars, featuring Cochrane Editor in Chief and members of the Cochrane community
Next week, the Guidelines International Network (G-I-N), an official Cochrane partner, will hold a series of online panels on guideline development and implementation – a ‘pitstop in the COVID-19 marathon’ for the guideline community.
The webinars (which will take place via Zoom) will focus on issues related to evidence synthesis and their impact on health recommendations and guidelines that have achieved much greater attention during the COVID-19 pandemic than perhaps ever before.
Several members of the Cochrane community, including Cochrane Editor in Chief, Dr Karla Soares-Weiser, will be participating. Karla will speak at Session 1 on September 30 (full schedule below), which focuses on issues related to preprints – including quality, and integration in systematic reviews and guidelines.
More information about the sessions and how to register are below.
Session 1: Quality of evidence for guidelines and recommendations
30/09/2020 10:00-12 noon (UK Time) (see time in your time zone)
Speakers: Christine Laine (Annals of Internal Medicine), Stuart Spencer (The Lancet), Karla Soares-Weiser (Cochrane) and Gerd Antes (Cochrane Germany)
Moderated by Holger Schunemann (GIN Scientific Committee, McMaster University).
Session 2: Rapid guideline development
30/09/2020 16:00-18:00 (UK Time) (see time in your time zone)
Speakers: Reem Mustafa (University of Kansas Healthcare System), Paul Chrisp (National Institute for Health and Care Excellence), Miloslav Klugar (Czech National Centre for Evidence-Based Healthcare), Waleed Al-Hazani (Surving Sepsis guidelines, McMaster University) & Adam Cuker (VTE guidelines and COVID).
Moderated by Christine Laine (Annals of Internal Medicine) & Tamara Kredo (Cochrane South Africa).
Session 3: Recommendation mapping
1/10/2020 14:00-16:00 (UK Time) (see time in your time zone)
Speakers: Tamara Kredo (Cochrane South Africa), Dennis Falzon (WHO), John Grove (WHO) & Zach Munn (Joanna Briggs Institute).
Moderated by Miloslav Klugar (Czech National Centre for Evidence-Based Healthcare) & Markus Follmann (German Cancer Society).
Session 4: Living Recommendations
2/10/2020 14:00-16:00 (UK Time) (see time in your time zone)
Speakers: Elie Akl (AUB Lebanon), Julian Elliot (Cochrane), Lisa Paddle (Public Health Agency of Canada), Marina Salvadori (Public Health Agency of Canada), Matthew Tunis (Public Health Agency of Canada) & Ole Wiechmann (Robert Koch Institute).
Moderated by Holger Schunemann (GIN Scientific Committee, McMaster University), Rodrigo Pardo (Universidad Nacional de Colombia, Bogotá) & Eddy Lang (University of Calgary and Alberta Health Services).
All sessions are free for G-I-N members; there is a £25 registration fee for non-members (or £75 to register for all four sessions).
Specifications: Full Time, Permanent
Location: London (preferably), Freiburg or Copenhagen
Application Closing Date: 6 October 2020 (At Midnight)
This role is an exciting opportunity to use your experience as a Project Support Officer to make a difference in the field of health care research.
The Project Support Officer will provide project management support, co-ordination, and administrative support to the Head of IT Services and the ITS department.
The role’s responsibilities will include:
- Provide administrative support, as required, to the Head of IT Services and the ITS Management Team. For example: arranging meetings and webinars, drafting agendas, meeting notes and documentation, and booking travel.
- Draft communications for key ITS projects and technology initiatives.
- Contribute to and manage documentation relating to the Cochrane technology strategy.
- Coordinate projects with other Central Executive Team (CET) departments.
- To develop good working relationships and shared working practices with the administrative leads within the CET.
- Develop a strong working knowledge of Cochrane’s processes and technologies for editorial management and content production and delivery.
- Identify key activities, areas of over-lap and inter-dependencies between various projects, areas of work, and other Cochrane strategies as they relate to projects and programmes of work within ITS and across the Central Executive Team.
- Undertake any other duties that may be considered appropriate.
The successful candidate will have:
- University degree and experience in project management or project management support and/or equivalent experience in a similar role
- Knowledge of project management and collaboration tools (e.g., Confluence, Jira)
- Ability to multitask and prioritize work requirements
- Effective communicator at all levels within and outside the organization
- The ability to work efficiently and effectively with a geographically-dispersed department and organization
- Good understanding of organisational effectiveness and of identifying and helping to implement best practice
- Excellent written, presentation and verbal communication skills
- Excellent team player
- Is diligent with attention to detail
- Willingness to travel as required
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.
- For further information on the role and how to apply, please click here
- The deadline to receive your application is by 6 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
- Interviews to be held on: w/c 12 October 2020
- Deadline for applications: 6 October 2020 (12 midnight GMT)
Lead author Patrick Fee explains, “This research is valuable when considering the significant impact of the COVID-19 global pandemic and its effect on dental services worldwide, limiting patient access for dental treatment. Patient access to dental care may remain limited for some time. However, the results of this review provide reassurance to those providing and seeking dental treatment that intervals between check-ups can be extended beyond six months without detriment to the oral health of patients.
This review finds that a risk-based check-up is not detrimental to oral health and is acceptable to patients. There has been a longstanding international debate about the optimal frequency of dental check-ups and this review includes the most current and robust evidence available to investigate this issue.”
Why have a dental check-up?
A dental check-up helps to keep your mouth healthy and lets your dentist see if you have any dental problems. It allows your dentist to deal with any problems early, or even better, to prevent problems from developing. Leaving problems untreated may make them harder to treat in the future.
What happens in a check-up?
At each check-up your dentist will usually: · examine your teeth, gums and mouth; · ask about your general health and if you have had any problems with your teeth, mouth or gums since your last check-up; · advise you about tooth-cleaning habits, and your diet, smoking and alcohol use. · if appropriate, recommend treatment needed for any dental problems. After your check-up, the dentist will recommend a date for your next check-up.
Traditionally, check‑ups are recommended every six months. However, some people are at higher risk of developing dental problems and may need more frequent check-ups, while others may not need check-ups so often.
Why the team did this Cochrane Review
Having check-ups every six months might help to keep your mouth healthy and avoid dental problems in future, but could also lead to unnecessary dental treatments. However, having check-ups less often might let dental problems get worse and lead to difficult and expensive treatment and care. The author team wanted to identify the best time interval to have between dental check-ups.
What did the authors do?
They searched for studies that looked at the effect of different time intervals between dental check-ups. The authors looked for randomised controlled studies, in which people were assigned to different intervals at random. These studies usually give the most reliable evidence. Search date: included evidence published up to 17 January 2020.
What did the authors find?
The authors found two studies with 1736 people who had regular dental check-ups. One study was conducted in a public dental clinic in Norway in children and adults aged under 20 years. It compared 12-monthly and 24-monthly check-ups, and measured results after two years. The other study was in adults at 51 dental practices in the UK. It compared six-monthly, 24‑monthly and risk-based check-ups (where time between check-ups depended on an individual's risk of dental disease), and measured results after four years.
The studies looked at how different intervals between check-ups affected: · how many people had tooth decay; · how many tooth surfaces were affected by decay; · gum disease (percentage of bleeding sites in the gums); and · quality of life (well-being) related to having healthy teeth and gums.
No studies measured other potential unwanted effects. What are the results of the review? In adults, there was little to no difference between six-monthly and risk-based check-ups in tooth decay (number of tooth surfaces affected), gum disease and well-being after four years; and probably little to no difference in how many people had moderate-to-extensive tooth decay.
There was probably little to no difference between 24-monthly and six-monthly or risk-based check-ups in tooth decay (number of people and number of tooth surfaces affected), gum disease or well‑being, and may be little to no difference in how many people had moderate-to-extensive tooth decay.
The authors did not find enough reliable evidence about the effects of 12-monthly and 24-monthly check-ups in children and adolescents after two years. This was because of problems with the way that the study was conducted.
How reliable are these results?
They are confident that there is little to no difference between six‑monthly and risk‑based check-ups in adults for number of tooth surfaces with decay, gum disease and well‑being. They are moderately confident there is little to no difference between 24-monthly check-ups and six-monthly or risk-based check-ups in number of tooth surfaces with decay, gum disease and well-being.
Whether adults see their dentist for a check-up every six months or at personalised intervals based on their dentist's assessment of their risk of dental disease does not affect tooth decay, gum disease, or well-being. Longer intervals (up to 24 months) between check-ups may not negatively affect these outcomes. Currently, there is not enough reliable evidence available about how often children and adolescents should see their dentist for a check-up.
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 2 of Strategy to 2020 challenged us to make Cochrane evidence accessible and useful to everybody, everywhere in the world.
Watch the video below to learn about Cochrane’s knowledge translation activities and the progress we have made toward Goal 2:
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.
Cochrane is made up of 11,000 members and over 67,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.
Getting involved in Cochrane’s work means becoming part of a global community. The Cochrane International Mobility programme connects successful applicants with a placement in a host Cochrane Group, learning more about the production, use, and knowledge translation of Cochrane reviews. The prgramme offers opportunities for learning and training not only for participants but also for host staff.
In this series, we profile those that have participated in the Cochrane International Mobility Program and learn more about their experiences.
Name: Mari Kinoshita
Cochrane International Mobility location: Cochrane Sweden
How did you first learn about Cochrane?
I vaguely recall how I first heard about Cochrane during my medical school years as “the resource for evidence-based medicine”, but I have to confess that I was not familiar with what the group was truly about until recently when I started to get involved in systematic reviews and appreciate its methodology while pursuing my PhD in Perinatal Medicine in Spain and Sweden. Meeting Matteo Bruschettini, the director of Cochrane Sweden, while I was doing one of my PhD projects in Lund (Sweden) was definitely a turning point for me. During a workshop in Lund, I summed up the courage to walk up and talk to him about my interest in Cochrane, and before I knew it, I was doing my CIM from Japan in Sweden, and here I am writing an article for Cochrane.org! When I first heard about CIM, I was excited to be a part of a form of collaboration between the two countries, Sweden and Japan.
What was your experience with Cochrane International Mobility?
The “official” one-month period of CIM in Lund was mainly about participating in Cochrane workshops to lay out the foundation of the methodology, and also about joining “in-person” team meetings for a systematic review “Opioids and alpha-2-agonists for analgesia and sedation in newborn infants: a systematic review”, of which the protocol has been recently published. This was all done alongside my PhD project and university courses at Lund University, thanks to the generous flexibility of the CIM program. I dearly miss the quaint university town that I fell in love with, but I feel that the best part of being physically in Lund (where Cochrane Sweden is located) was the warm, welcoming atmosphere of the Cochrane team and the consistent mentorship of Matteo. Matteo guides you through the necessary steps regardless of what your experiences are, and I have been very fortunate to be able to build a great relationship with a mentor whom I hold with great respect and admiration. Moreover, the mobility experience between Sweden and Japan has enabled me to connect with Cochrane Japan and its director, Norio Watanabe. I was also new to Cochrane Japan, but Norio has welcomed me with open arms and a big smile. CIM is often between countries within Europe due to geographical proximity, so if my CIM can contribute in any way to promote collaboration between the Cochrane teams in two of my favorite countries, that itself would be rewarding to me as a way to give back for what I have received from both teams.
What are you doing now in relation to your Cochrane International Mobility experience?
Even after leaving Sweden, I have stayed strongly connected to Cochrane Sweden and currently continuing to work together on a few reviews, including a new Cochrane Neonatal review on opioids for postoperative pain in newborns. We regularly contact each other in the review team through emails and discuss important issues at online meetings; I have also been attending many Cochrane webinars online since there is always more to learn!
Do you have any words of advice to anyone conserving a Cochrane International Mobility experience?
If you are in any bit interested in systematic reviews and evidence-based medicine, CIM is a valuable opportunity that can open many doors – so do not hesitate to reach out! Going to a new country and meeting new people can be daunting, especially if you feel that you do not have experience in the field, but really, the only thing you need to bring with you is yourself and your spark of interest! The rest is for you to find or not find on your journey in Cochrane with the supportive team behind you. How you continue your journey after CIM is totally up to you, and whatever you choose, your CIM experience would definitely have added another page in your one-and-only book. The personalized program is a casual way for anyone to get a glimpse into the worldwide network, and as it has been for me, I am sure that it would end up being only the beginning…
Monday, September 28, 2020
Featured Review: Using mobile technologies to promote communication and management of care between healthcare professionals
Many healthcare workers work alone or have little access to colleagues and specialists. This is a common problem for healthcare workers in rural areas or low‐income countries. One possible solution to this problem is to offer healthcare workers advice and support through mobile technologies that allow healthcare workers to get help from colleagues who are not in the same place. For instance, healthcare workers can contact specialists or colleagues with more experience through a phone or the Internet. Healthcare workers can also use their mobile phones or other mobile devices such as tablets.
This systematic review from Cochrane Effective Practice and Organisation of Care looked at if healthcare workers using services through their mobile phones or other mobile devices to communicate with other healthcare workers provide quicker access to healthcare, and improve patient health outcomes. Included in this systematic review are 19 relevant studies, which included more than 5766 people who needed health care. Sixteen studies were from high‐income countries.
Mobile technologies probably slightly decrease the time to deliver health care, as well as the number of face‐to‐face appointments, when compared with usual care, and probably increase the number of people receiving clinical examinations for some conditions, including an eye exam for people with diabetes. Mobile technologies may have little or no impact on healthcare workers' and participants' satisfaction, health status or well‐being.
Daniela Gonçalves-Bradley, lead author of the review says, “This review looks at the evidence for three different healthcare scenarios; primary healthcare workers consulting with hospital specialists, emergency doctors consulting with hospital specialists, and community health workers or home‐care workers consulting with clinic staff. The evidence shows that using mobile phones and devices for the communication between health professionals may improve some outcomes; however our confidence in the effect estimates is limited by the certainty of the evidence. As this is a growing area of work, we hope that there will be more robust studies in a future update that will address data‐sharing and privacy concerns and identify common core outcomes.”
Producing high quality synthesised evidence rapidly in relation to COVID-19 is clearly critical if researchers, clinicians, the public and policy makers are to make headway in understanding and managing this new coronavirus.
One key area being addressed by a Cochrane Rapid Review is: Quarantine alone or in combination with other public health measures to control COVID. The initial Rapid Review was published in April 2020. Within months, due to the sheer pace and volume of research being undertaken on COVID-19, an update was needed. The search for new evidence identified an eye-watering 5000 references to assess.
Enter Cochrane Crowd: Cochrane’s amazing community of citizen scientists, healthcare students, professionals and researchers who all work together to identify and describe health research.
The Crowd were tasked with assessing the new search results for potential relevance to the review. This task was more challenging than the usual Cochrane Crowd tasks as they were being asked to identify a range of different study designs (for example, modelling studies and observational studies as well as any relevant interventional studies).
Another key difference with this task was the time limit. Cochrane Crowd tasks for reviews usually come with a two-week deadline. For this task, the Crowd were given just 48 hours.
Friday, September 18, 2020
The Crowd completed the task within 22 hours, making over 17,000 individual classifications on records. Sixty-five crowd contributors took part with forty-five screening enough records to earn named acknowledgment in the review. Senior authors of the review, Barbara Nußbaumer-Steit and Gerald Gartlehner were very impressed: “Wow! That is amazing” and “That is incredible”.
Cochrane Crowd have been helping to identify studies for Cochrane reviews and for Cochrane’s Central Register of Controlled Trials for some time now. This new task helped to demonstrate the potential for increased Crowd involvement in reviews that include study designs other than randomised trials. It also demonstrated the speed at which this unflappable community can work when faced with important questions that need answering.
For more information about Cochrane Crowd, visit https://crowd.cochrane.org
Three new reviews have published on mouthwashes/nasal sprays to protect healthcare workers and patients from COVID-19 infection. Healthcare workers are at the forefront of the COVID-19 crisis, with repeated exposure to individuals who are, or may be, infected, and are therefore at risk themselves.
These workers may be especially at risk when undertaking 'aerosol-generating procedures' (AGPs). This is any medical, dental or patient-care procedure that results in the production of airborne particles (aerosols) from the upper aerodigestive tract (mouth, nose, throat, oesophagus) and lower respiratory tract where the virus is shedding. These can remain suspended in the air and travel over a distance. They may cause infection if they are inhaled. Such procedures therefore create the potential for airborne transmission of infection.
This set of three reviews looks at the use of antimicrobial mouthwashes and nasal sprays
- by healthcare workers treating patients with suspected or confirmed COVID-19 infection;
- by patients with suspected or confirmed COVID-19 infection and
- by patients without suspected or confirmed COVID-19 infection, who are undergoing aerosol-generating procedures (AGPs), and the healthcare workers (HCWs) treating them.
The author team, a collaborative team from Cochrane’s Oral Health and Ear, Nose, Throat groups identified no completed studies for inclusion in any of these systematic reviews, which is not surprising given the relatively recent emergence of COVID-19 infection.
However, the authors did identify a number of ongoing studies, which have been recorded and will be monitored for completion with a view to updating the reviews as the results become available.
Read the reviews:
- Use of antimicrobial mouthwashes (gargling) and nasal sprays by healthcare workers to protect them when treating patients with suspected or confirmed COVID-19 infection
- Antimicrobial mouthwashes (gargling) and nasal sprays administered to patients with suspected or confirmed COVID-19 infection to improve patient outcomes and to protect healthcare workers treating them
- Antimicrobial mouthwashes (gargling) and nasal sprays to protect healthcare workers when undertaking aerosol-generating procedures (AGPs) on patients without suspected or confirmed COVID-19 infection