Cochrane systematic reviews can help us to make healthcare decisions based on up-to-date research evidence. They are systematic because they search for and analyse evidence in a systematic way, according to predetermined and published methods. Each systematic review answers a specific healthcare question by gathering all the relevant studies, assessing the reliability of these studies, then summarising their results to produce a summary of all of the available evidence.
One type of systematic review is a diagnostic test accuracy (DTA) review. In addition to investigating test accuracy, they ideally also investigate why the results may vary among studies, compare the performance of alternative tests, and help the reader to put the evidence in a clinical context. Watch the video below and read on to learn more about DTA reviews.
Cochrane DTA reviews are a type of systematic review that aim to evaluate the accuracy of diagnostic tests. They want to find out whether a new test is more accurate than an existing test, or whether it is quicker, cheaper or easier to perform. Answers to these questions help patients and healthcare workers make informed decisions about which test to use, based on up-to-date evidence.
DTA reviews evaluate how well diagnostic tests (index tests) identify or exclude a particular disease or condition (the target condition). We know that diagnostic tests make errors, even when they are correctly performed. There are two types of test errors: false positive test errors (the index test suggests the target condition is present when it is not) and false negative test errors (the test suggests the target condition is absent when it is not). Cochrane DTA reviews can cover all types of diagnostic tests, from antibody tests to X-rays, for any disease or condition. It is really important that diagnostic tests provide accurate results so that people can receive prompt treatment or take preventive measures if necessary, and to avoid unnecessary testing, treatment and anxiety.
DTA reviews search for all relevant test accuracy studies, appraise the studies for reliability, and combine their results. This gives the best possible estimate of the accuracy of an index test based on all the available evidence. DTA reviews are systematic because they search for and analyze evidence in a systematic way, according to predetermined and published methods.
Test accuracy studies most often report accuracy using sensitivity and specificity.
- Sensitivity means the proportion of people with the target condition who are correctly detected by the index test.
- Specificity means the proportion of people without the target condition who are correctly identified by the index test.
Therefore, the nearer the sensitivity and specificity are to 100%, the better the test.
An alternative way to report test accuracy is using positive and negative predictive values, which tell us about the usefulness of a positive index test result and a negative index test respectively – this helps patients understand how reliable their test results are. Predictive values measure the number of positive index test results that will be true positives and the number of negative index test results that will be true negatives. The nearer the positive and negative predictive values are to 100%, the better the test.
In April 2020, Cochrane launched the COVID-19 consumer rapid response group. Currently, nearly 100 people with lived experience related to COVID-19 have joined the group, signing up to offer their time, skills, and experience to get involved with Cochrane’s work on COVID-19 rapid reviews and accommodate limited timelines. Thus far, 16 consumers have been connected with research teams for 13 COVID-19 rapid reviews, either as members of author teams or as peer reviewers. Interested consumers can still become involved in the COVID-19 consumer rapid response group; find out more and sign up.
As the full implications of the Coronavirus (COVID-19) pandemic became clear earlier in 2020, Cochrane made synthesizing relevant evidence for prevention and treatment its number one priority. Cochrane authors, editors, consumers, and other collaborators were motivated to do COVID-19 research, and Cochrane quickly mobilised its global community to undertake a series of rapid reviews, among other COVID-19 response work. The involvement of healthcare consumers (patients, carers, and the public) is a Cochrane policy and is part of guidance for the production of rapid reviews. With COVID-19, however, it quickly became clear that Cochrane needed to facilitate collaboration between review teams, editorial staff, and consumers in the short time available for completing a rapid review.
Long-time Cochrane collaborator and patient and caregiver involvement researcher, Lyubov Lytvyn (@lyubovlytvyn), was interested in how Cochrane could use its platform. “I lead the patient and caregiver partnership initiative for the MAGIC/BMJ Rapid Recommendations (international clinical practice guidelines with linked systematic reviews, infographics, and decision aids), and am doing my PhD on this topic. When I saw Cochrane’s rapid reviews, I reached out to ask how they were involving consumers, to inform my own work. It turned out that, while it was part of their guidance, there wasn’t an easy process to help connect consumers and review teams in a short time frame.”
To address this, a task group was quickly formed, made up of consumers, researchers, and others who have led Cochrane’s consumer-involvement work. It swung into action, quickly identifying the ways in which tools and resources could be developed to help consumers and researchers partner together. Drawing on previous work - including Involving People (learning resource for systematic review authors), and Evidence Essentials (free online resource offering an introduction to health evidence and how to use it to make informed health choices) - the group put together a web page of resources, including:
- Learning for people who wanted to get involved;
- Support for volunteers, including a group of experienced consumers who could offer peer support;
- A series of “how to” one-page guidance for consumers and review teams; and
- Some short videos that explained how to get involved.
While putting together these resources, recruitment of volunteers from around the world with lived experience related to COVID-19 began, and the response was impressive. To date, 97 people have signed up to assist with the important task of providing consumer input into COVID-19 research. People can continue to get involved here.
Ndi Euphrasia Ebai-atuh (@Euphras01426918) from Cameroon was the first consumer to be linked with a rapid review research team. The review looks at community-level interventions for improving access to food in low- and middle-income countries. Of the experience working with the team thus far, Euphrasia commented “I felt represented as a consumer even during ‘no time to waste’ research circumstances such as these, under the COVID-19 pandemic...It gave me a platform to amplify the voices of millions of consumers in LMICs with poor food access, despite numerous past and ongoing community-level interventions for improving access to food. I felt once more reassured of Cochrane’s commitment to consumer involvement and will call on the entire Cochrane community of researchers to take advantage of consumer involvement in research, for it can greatly improve evidence uptake!”
Jodie Doyle, Managing Editor of the Public Health Group overseeing the review added, “Not only did Euphrasia return her very useful comments to us within 7 days, upon follow-up she also provided advice on organisations and individuals to whom we should disseminate the published review.”
Vivek Podder was recruited for the protocol of the Cochrane rapid review, "Effectiveness of Contact Tracing Technologies in Epidemics", as a consumer referee for Cochrane Public Health. Jodie commented, “Vivek got his feedback to us quickly and provided really good insight from the perspective of a consumer in an LMIC. The editorial and authorship team are really grateful for his input.”
Over recent months, it has become clear that research on COVID-19 will be a priority for the foreseeable future. The voices of those with lived experience of this disease, whether as a patient, carer, or member of the public, will be important to producing relevant synthesized evidence going forward. Not all volunteers have been connected with research teams yet, and the task group is looking for new ways to involve consumers in Cochrane’s COVID-19 efforts. There are also plans to evaluate and present this innovative consumer involvement work for the wider research community.
Karla Soares-Weiser, Editor in Chief of the Cochrane Library, was enthusiastic about the process: “I’m delighted that we have been able to embed consumer involvement in our rapid review processes so efficiently. Involving stakeholders is critical to producing evidence that meets their needs, so it is fantastic to have this COVID consumer group available to provide high quality, rapid input that makes a difference to our reviews.”
Richard Morley, Consumer Engagement Officer for Cochrane, says “In these troubling times, it’s been so heartening to see people volunteering to help get the evidence that health professionals, patients, carers and policymakers need to respond to this public health crisis. Thank you to everyone.”
Find out more about Cochrane’s key achievements during 2018 and the strides being made on our major Strategy to 2020 initiatives.
"We exist so that people around the world can use Cochrane evidence to inform their health decision-making; and 2019 saw another substantial increase in the number of people who are doing that. In 2017, 22 million visits were made to Cochrane.org to access our evidence; in 2018 visits rose to 37 million; and in 2019 that figure more than doubled to over 77 million – that’s a 350% increase in only two years! Three-quarters of those users are accessing our evidence in non-English language browsers, so we are truly offering a service to healthcare practitioners, policymakers, researchers and patients and the general public around the world."Mark WilsonCochrane Chief Executive Officer
Cochrane Library Editor in Chief and Deputy Editor in Chief, Karla Soares-Weiser and Toby Lasserson, presented to a large group of international journalists as part of the Wiley Science Talks webinar. This webinar series, supported by the World Federation of Science Journalists and the Association of Health Care Journalists, provides educational webinars for journalists around the world.
Karla and Toby’s presentation, entitled “Understanding Health Evidence—A COVID-19 Case Study” introduced Cochrane, explained what systematic reviews are, and shared what makes Cochrane Systematic Reviews unique. They then presented an overview of Cochrane’s response to COVID-19 and shared a case study focusing on the quarantine rapid review. Using this review, they showed journalists what conclusions could be drawn from the study, how a well-written article about the review could be constructed, and the importance of keeping study results in context.
Citizen scientists help to expand Cochrane Library’s trial register to include more nursing and allied health research
The Cochrane Central Register of Controlled Trials (CENTRAL) is a highly concentrated source of reports of randomized and quasi-randomized controlled trials (RCTs) that publishes each month as part of Cochrane Library. CENTRAL assists Cochrane authors and other systematic reviewers around the world quickly find evidence to determine whether a treatment works.
We're pleased to announce that the May issue of CENTRAL on Cochrane Library includes approximately 14,000 references to RCTs identified from CINAHL (Cumulative Index of Nursing and Allied Health Literature) and published under license with EBSCO. CINAHL is an essential source of nursing research and publications on 17 allied health disciplines, including physical therapy, occupational therapy, nutrition and dietetics. Along with the RCTs in CENTRAL from PubMed, Embase, ClinicalTrials.gov, the World Health Organization’s International Clinical Trial Registry Platform (ICTRP), KoreaMed, and the individual registers of Cochrane Review Groups, CINAHL RCT records expand the subject area coverage of CENTRAL, making it an even more comprehensive source of RCTs.
The project to include CINAHL RCTs in CENTRAL began in September 2018 with the help of our citizen scientist platform, Cochrane Crowd. Cochrane Crowd is a global community of volunteers who are helping to classify the research needed to support informed decision-making about health care. The job of the Cochrane Crowd community is to review descriptions of research studies to identify and classify RCTs. Reports of RCTs are then fed into Cochrane’s Central Register of Controlled Trials.
Thanks to the efforts of the Cochrane Crowd community, Cochrane's Centralised Search Service Project Team and our colleagues at EBSCO, Metaxis, Wiley and HighWire, we are now adding CINAHL RCT records to CENTRAL. We will publish a “backlog” over the next three months that will contain older references as well as newer ones. New CINAHL records available from CENTRAL may increase results for saved searches. By August, we'll add new CINAHL RCTs to CENTRAL monthly just as we do for our other sources.
Tuesday, June 2, 2020
Telephone interventions for managing symptoms in adults with cancer. This is particularly important at the moment for people with cancer, who have been advised to stay at home due to COVID-19.
People with cancer experience a variety of symptoms such as depression, anxiety, fatigue and pain caused by their disease and its treatment. These are often managed, day-to-day, by patients or their family members. Poor management of symptoms may lead to other problems, such as difficulties in carrying out everyday tasks, poor sleep, and poor quality of life.
Cancer specialists have developed psychological and educational interventions to provide support for the management of a range of cancer symptoms. These interventions can often be delivered by telephone in the patients’ homes instead of face-to-face in hospital. This is beneficial for patients and their families, who would normally have to travel to hospital for outpatient appointments. This is particularly important at the moment for people with cancer, who have been advised to stay at home due to COVID-19.
Cochrane Review authors aimed to answer the following questions.
- Are telephone interventions for adults with cancer effective in relieving symptoms of cancer and cancer treatment?
- Which symptoms are most reduced when telephone interventions are used?
- What aspects of telephone interventions have the most impact in reducing cancer symptoms?
In this systematic review, telephone interventions were interventions given only, or mainly, by telephone. They were given by health professionals. As well as telephone contact, they could include face-to-face contact, or printed, digital or online information.
The review included 32 studies with a total of 6250 participants. Studies could compare telephone interventions with another telephone intervention, with another type of intervention (e.g. face-to-face), or with usual care. Participants in these studies were adults with any kind of cancer at any stage. Most studies (21) were from the USA. Nine studies recruited women with breast cancer, 11 included people with breast, colorectal, lung, or prostate cancer. Fourteen studies included people with early-stage cancer. Nurses provided interventions in 24 studies. Only 10 studies delivered interventions solely by telephone, and 16 studies combined telephone calls with other materials (printed or digital). Studies measured symptoms of depression, anxiety, emotional distress, uncertainty, fatigue, pain, sexual symptoms, and breathlessness. They also measured the effect of all the symptoms together (the general symptom experience).
Most studies compared a telephone intervention with usual care alone or usual care with additional support. Eight studies compared two telephone interventions against each other; some also compared these with usual care.
The review authors analysed the results from studies that recorded change scores, or for which they were able to calculate change scores.
Twenty-one studies provided evidence on symptoms of depression compared to usual care or other interventions, but only nine provided data that could give change scores. These found that telephone interventions appeared to reduce symptoms of depression. Likewise, telephone interventions appeared effective compared to usual care or other interventions in reducing anxiety (16 studies; 5 contributed change scores); fatigue (9 studies; 6 contributed change scores); and emotional distress (7 studies; 5 contributed change scores).
Telephone interventions are convenient for patients, their families and healthcare workers and they appear to relieve some symptoms of cancer and cancer treatment. However, the studies were small, very different from each other, and some evidence was conflicting. It is unclear whether telephone interventions alone, or combined with face-to-face meetings, or printed or audio materials, are most effective in reducing the many symptoms that people with cancer experience. The authors rated the certainty of the evidence as very low.
This review includes evidence published up to January 2019.
The Cochrane Centre of the UTE University of Ecuador receives the "General Rumiñahui" award for its work related to the COVID-19 pandemic
The UTE University of Ecuador has received the "General Rumiñahui" award by the Pichincha Provincial Council for its fight against the spread of COVID-19. The Cochrane Centre's collaborating team has been recognized for their work on epidemiological research at the UTE. This award acknowledges their valuable contribution in modeling the evolution of the pandemic in the province; a fundamental task for taking preventive measures during the country's health emergency.
On May 24th, a virtual event was held at the UTE to celebrate the award. Cochrane and Cochrane Iberoamerica would like to congratulate our colleagues Ricardo Hidalgo, Daniel Simancas, Andrés Viteri, and the rest of the Cochrane Ecuador team on this recognition. We are very grateful and proud of their contribution in managing the pandemic and their involvement in Cochrane.
Health guidance suggests that reducing the amount of saturated fat we eat, by cutting down on animal fats, is good for our health.
In the process of updating this review the authors wanted to know whether following this advice leads to a reduced risk of dying or getting cardiovascular disease (heart disease or stroke). They assessed the effect of replacing animal fats and hard vegetable fats with plant oils, unsaturated spreads or starchy foods, for at least two years, on health outcomes including dying, heart disease and stroke. They only looked at studies of adults (18 years or older). They included men and women with and without cardiovascular disease. They did not include studies of acutely ill people or pregnant or breastfeeding women.
The review authors found 15 studies with more than 59,000 participants. The review found that cutting down on saturated fat led to a 21% reduction in the risk of cardiovascular disease (including heart disease and strokes) but had little effect on the risk of dying. The review found that health benefits arose from replacing saturated fats with polyunsaturated fat or starchy foods. The greater the decrease in saturated fat, and the more serum total cholesterol is reduced, the greater the protection from cardiovascular events. People who are currently healthy appear to benefit as much as those at increased risk of heart disease or stroke (people with high blood pressure, high serum cholesterol or diabetes, for example), and people who have already had heart disease or stroke. There was no difference in effect between men and women.
This means that, if 56 people without cardiovascular disease, or 32 people who already have cardiovascular disease, reduce their saturated fat for around four years, then one person will avoid a cardiovascular event (heart attack or stroke) that they would otherwise have experienced.
There is a large body of evidence assessing effects of reducing saturated fat for at least two years. These studies suggest that reducing saturated fat reduces our risk of cardiovascular disease. The review authors rated the quality of the evidence as moderate.
The evidence is current to October 2019.
- Read the review
- Cochrane Review on Saturated fats included in report published by Public Health England
- Learn more about Cochrane Heart
Thursday, May 28, 2020
Interview with the artist who created a stop motion animation of the Cochrane review 'Protective clothes and equipment (PPE) for healthcare workers to prevent coronavirus and other highly infectious diseases'.
Stop motion is an animated filmmaking technique in which objects are physically manipulated in small increments between individually photographed frames so that they will appear to exhibit independent motion or change when the series of frames is played back. UK animator, Beth Adams, uses this technique and paper drawings and cut outs to make short films. She recently created a video about Cochrane PPE evidence and spoke to us more about her work.
It's such an impressive video that you have made. What’s your background?
I’m a History and Archaeology graduate from Nottinghamshire. Currently I’m filling the lockdown hours with animation projects.
So you don't have a health background?
No! I am very much the artsy type. However, my medical researcher parents have ingrained in me an appreciation for the importance of clinical trials and evidence lead research.
How did you get started in this craft?
In my final year at university I picked a Outreach and Engagement course, which required the creation of a educational engagement project. I decided to produce an animated video series called Roman About. The aim was to make archaeology accessible and relevant to young people through the themes of identity and multiculturalism in Roman Britain.
In hindsight teaching myself stop motion animation during final year maybe wasn’t the best idea, but since then I’ve become a bit animation obsessed. I love that a thirty second video can convey the same information as a thousand word article, and enjoy making complicated concepts engaging and relevant to a general audience.
You recently did a video about the Cochrane systematic review called 'Protective clothes and equipment (PPE) for healthcare workers to prevent coronavirus and other highly infectious diseases'. It's a different topic area for you - what lead you to it?
I am most interested in producing educational, explanatory animations and was looking for my next topic. My mum, who is involved in the medical research charity Evidence Aid, put me in contact with one of its founders Professor Mike Clarke. Mike is also podcast editor at Cochrane and suggested I make an animation for the PPE review based on the podcast transcript. It made sense to animate this review as it’s so topical and well suited for using a few visual aids to bring the words to life.
What was most challenging about this project?
This was my first commission and attempt at animating for an adult audience. I usually write the script with an accompanying animation in mind and don’t have to worry and the needs of a second party. Coming up with visual aids that were accurate and appropriate but still had some humour, was definitely a challenge.
Being fairly new to stop motion and entirely self-taught, there’s also always the challenge of getting a semi-professional looking video with my B in GCSE art, an old iPhone and a £5 tripod.
You certainly pulled it off! Given your background, did you have to research any of the PPE visuals?
I hadn’t heard of most of the PPE examples featured in the podcast, so did some online research to make sure my animations were accurate. I had no idea that PPE varies so much across space and time.
It looks like a tedious process. How long did it take to make?
This video took me about ten days including planning and editing. My parents had had enough of little paper men all over the carpet after about a week.
- View other work by Beth Adams
- Follow Beth Adams on Instagram
- Read all the Cochrane resources and news on COVID-19
Wednesday, May 27, 2020
The Cochrane Training team is excited to share an overview of its online learning offerings
Recognizing that many people are abiding by recommendations to stay home in light of the COVID-19 pandemic and may like to do some learning, the Cochrane Training team has compiled the following opportunities for members of the Cochrane community, as well as teachers, students, and anyone interested in brushing up on their evidence synthesis skills.
The Training team has been pleased to hear feedback from several universities using Cochrane’s online learning materials to support teaching efforts in these times where most in-person teaching activities are on hold. In parallel, Cochrane is hosting more webinars than ever before, including the recently announced nine-part webinar series on Risk of Bias 2.
Cochrane Interactive Learning, designed with leading experts in the evidence synthesis world, is aimed at new and experienced systematic review authors. It currently comprises 11 in-depth modules on conducting an intervention review. It is quite extensive, providing over 15 hours of self-directed learning materials. Most modules are also available in Spanish.
Highlights include Module 3: Searching for studies, which is practical for anyone looking to brush up on their search skills, and Module 6: Analysing the data, for those skills that even seasoned reviewers need to keep fresh. There are also specialised topics such as conducting a network meta-analysis, equity in reviews and an intro to health economics. The first module, Introduction to conducting systematic reviews, is open to everyone (also in Spanish).
Cochrane Evidence Essentials is an introductory course to evidence based medicine in four modules, covering its history, the importance of randomized controlled trials, understanding systematic reviews and using them for making health decisions. It is excellent for patients, clinicians, undergraduates of health sciences and anyone interested in EBM. Access is open but requires logging in with a Cochrane account (free).
There's a lot of interest in clinical trials for treatments for COVID-19. Evidence Essentials is a set of resources about evidence-based medicine, clinical trials and systematic reviews.
The course follows Eleni, a young woman from Greece that is based in the UK, who becomes involved in a health-related scenario affecting her aunt. As a person without a background in health, she quickly becomes oriented with the basics to be able to apply her knowledge using Cochrane evidence, and make decisions together with her health providers.
In addition to Interactive Learning and Evidence Essentials, there are also various specialised learning modules including the recently launched Synthesis Without Meta-analysis (SWiM) reporting guidelines, teaching authors how to foster transparency in reviews that do not incorporate meta-analysis. Other notable modules include Involving People and Common Errors.
Cochrane Learning Live is the Cochrane Training webinar series. Several webinars are held each month, all of which are open to anyone via sign-up in the link provided. The Learning Live page lists upcoming webinars, and toward the bottom there are archives of all past webinar recordings. See the lists below of top archived webinars by attendance and number of video views; the list below reflects those with more than 20,000 views.
Top archived webinars by attendance
- Introduction to new Cochrane Handbook for Systematic Reviews of Interventions, January 2019
- Introducing RoB 2, May 2020
- Get to know RevMan Web – the new review writing tool, August 2018
- Covid-19 Rapid Reviews: Cochrane’s Response so far, April 2020
- An introduction to individual patient data meta-analysis, November 2018
Top archived webinars by video views
- Covidence: Cochrane's new online tool for streamlined review production, March 2016
- Using GRADE and the GRADEpro GDT online software in your Cochrane Review, May 2016
- RoB 2.0: A revised tool to assess risk of bias in randomized trials, November 2016
- Scoping reviews: what they are and how you can do them, August 2017
Remember to follow Cochrane Training on Twitter for announcements of upcoming webinars and new online learning opportunities. Get in touch by contacting the Training team at email@example.com or via Twitter.Particularly notable is the star-studded nine-part Risk of Bias 2 webinar series that recently started. Other notable webinar series include the NMA series and the Patient and Public Involvement Network series.Monday, May 25, 2020
All of Cochrane’s COVID-19 related evidence will continue to be freely available to everyone, everywhere on the Cochrane Library (full text) and at Cochrane.org.
Cochrane’s response to the COVID-19 pandemic is providing high-quality, relevant and up-to-date synthesized research evidence to inform health decision-making in containing and combating the effects of the virus (for full details see the COVID-19 pages on Cochrane.org and the Cochrane Library).
Since 26th March, Cochrane – with its publishing partner, Wiley – granted everyone in every country of the world, temporary unrestricted access to the complete Cochrane Library. This unprecedented decision ensured Cochrane evidence was accessible for all those involved in combating the pandemic and its effects on global public health until Cochrane could curate, develop and publish more specific COVID-19-related evidence.
Over the last two months Cochrane has published:
- Six ‘Special Collections’ of Cochrane evidence relating to the prevention and treatment of COVID-19, containing 106 Cochrane Reviews and 67 Cochrane Clinical Answers (to support decision-making for health professionals). These Special Collections were developed based on World Health Organization (WHO) interim guidance and are updated in response to new information;
- Five Cochrane Rapid Reviews published with accompanying podcasts and six related Cochrane Clinical Answers;
- A full Cochrane Review on Personal Protective Equipment for healthcare staff;
- All of this evidence is translated in up to 12 other languages to promote its global accessibility and use; and Cochrane Reviews are also being made openly available on the Wiley Online Library along with other relevant Wiley content;
- Cochrane’s ‘COVID-19 Study Register’ of primary research studies, in consultation with WHO, which has become one of the largest and most sophisticated registers in the world;
- The April 2020 issue of the Cochrane Library App, featuring abridged versions of Cochrane Reviews relevant for COVID-19 (available from Google Play (Android devices) or the App Store (iPhone and iPad));
- The Cochrane Library Journal Club (Issue #97), focusing on a Cochrane Review related to COVID-19 response preparation.
All of this material – and all of Cochrane’s future COVID-19 related evidence – will continue to be freely available to everyone, everywhere on the Cochrane Library (full text) and at Cochrane.org. Cochrane and Wiley will also continue to provide free one-click access to the complete Cochrane Library for those living in 126 Low- and Middle-Income Countries. But normal access controls to the Cochrane Library will be re-introduced today and subscribed content will only be available to users who have a license.
Last week, Cochrane set out the new COVID-19 evidence it was developing to be published and made freely available in the next stage of its response over the coming six months (for more details, see here). This will include:
- Two new ‘Special Collections’ to be published in June on: ‘Support for mental health and wellbeing in the healthcare workforce’; and ‘Clinical rehabilitation and support following acute illness and traumatic experiences’.
- Cochrane Rapid Reviews, Cochrane Systematic Reviews and Network Meta Analyses covering:
- Clinical management of COVID-19 related topics on screening and testing; drug treatment; clinical care; prophylaxis; prognosis; and pandemic-related impacts on health;
- Public health measures including prevention of infection and personal protection; and
- Economic and social responses to the pandemic.
Cochrane’s Editor in Chief, Karla Soares Weiser, said: “Cochrane rose to the unprecedented global challenge of responding to COVID-19 by ensuring that our health evidence was immediately accessible for all people in all places across the world as the pandemic accelerated during March and April. This has been a hugely valuable in providing open access to our high-quality, trusted information. We will continue to work on producing and making freely accessible the highest quality evidence on the most important developing questions required to help support the response to this global health crisis.”
More than 10,000 users in its first month: Cochrane's COVID-19 Study Register supports rapid evidence synthesis in the global challenge to combat COVID-19
Less than two months after its launch, Cochrane’s ‘COVID-19 Study Register’ has become one of the largest, most sophisticated and well-used resources for researchers needing to access and analyze the huge growth in primary studies being conducted on COVID-19. Since 7 April, Cochrane’s COVID-19 Study Register has attracted more than 10,000 users from around the world, accessing over 44,000 pages. The Register is constantly improving with the ambition of becoming the definitive source of studies on COVID-19.
The aim of Cochrane’s COVID-19 Study Register (accessible at: https://covid-19.cochrane.org/) is to support rapid and living evidence synthesis by all systematic review producers, as well as Cochrane's own work on COVID-19-related Rapid Reviews, Systematic Reviews and Network Meta-Analyses. 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.
With the rapid proliferation of global research related to COVID-19, it is increasingly challenging for researchers efficiently to find all relevant literature on this topic. The Cochrane COVID-19 Study Register removes the need to conduct extensive searches elsewhere, as it is continually updated with human studies on COVID-19 from trial registry platforms and PubMed. References from preprint archives and grey literature repositories that contain preliminary reports of in-process publications, organizational reports and policy literature produced outside of traditional publishing and distribution channels are also being added to the register. The register makes COVID-19 study evidence easy to find and filter through faceted search and browse options, including study characteristics and PICO (Population Intervention Comparator and Outcome) descriptors. The register’s universal data export formats (RIS and CSV) also makes new evidence simple to share and integrate into review production.
Cochrane will continue to develop, improve and extend the comprehensiveness of the COVID-19 Study Register in the weeks and months ahead.
In May and June, the Register will:
- Increase its coverage by adding approximately 2,000 records from reputable preprint archives;
- Enhance searching with new filters for publication type and studies reporting results;
- Add PICO descriptors for all controlled trials; and
- Develop new surveillance and alerting features that will notify researchers to emerging evidence from the global response to COVID-19.
Upcoming opportunities to help build the COVID-19 Study Register will be available soon through Cochrane Crowd.
To find out more and get involved:
New Cochrane Rapid Review - Video calls for reducing social isolation and loneliness in older people
Many countries have introduced restrictions on people’s movement to protect them from COVID-19. Visiting older friends and relatives may not possible. Can calling Grandma with a video call help her feel less lonely and isolated? Can video calls affect symptoms of depression or quality of life? What does the evidence say?
COVID-19 is spreading rapidly, so we needed to answer this question quickly. This Rapid Review was done in a short space of time as part of Cochrane’s organizational effort to meet the need for up-to-date summaries of evidence to support decision-making in combating the effects and impact of COVID-19
The review authors looked for studies that randomly allocated older people to different groups to use either video calls, another method of keeping in touch, or no particular method (usual care), with the aim of examining their effects on loneliness or social isolation. For this review they considered older people to be aged 65 years or above and considered video calls to be calls made via the internet, using computers, tablets or smartphones.
The team included three studies, with 201 participants, in this review. All three studies took place in nursing homes in Taiwan between 2010 and 2020 and compared video calls to usual care.
The evidence from these three studies suggests that video calls have little to no effect on loneliness after three, six or 12 months. There is also little to no difference in symptoms of depression after three or six months, although after a year, older people who used video calls may have had a small reduction in depression compared to those who received usual care. Similarly, video calls may make little to no difference to older people’s quality of life.
Our certainty (confidence) in the evidence was limited because we found few studies with a small number of participants, and they either used unreliable methods or did not fully describe their methods. Also, all of the participants were in nursing homes, so our findings may not apply to older people living in other places, such as their own homes. Also, some of the participants may not have been feeling lonely or socially isolated.
Based on the current evidence, we are unable to say whether video calls help to reduce loneliness in older people. We need more studies, that use rigorous methods to investigate this question, and focus on older people who are lonely or socially isolated.
Friday, May 22, 2020
Cochrane identifies its priority areas for future COVID-19 work and lists other critical questions for the research community
Cochrane today announces its COVID-19 priority areas of work over the next six months to help meet the healthcare evidence needs of policymakers, guideline developers and clinicians; and makes available a list of additional priority questions to help guide the work of other research organizations.
Since 18 March, Cochrane has been gathering some of the most important questions related to the COVID-19 pandemic from health researchers, clinicians, policymakers, patients and carers, as well as important external stakeholders including the World Health Organization (WHO), the UK National Institute for Health Research (NIHR) and guideline developers from different countries. Cochrane experts reviewed these questions in collaboration with health and policy decision-makers, resulting in Cochrane’s Question Bank, a resource that is now being made available to the global research community.
The Question Bank includes approximately 150 questions, categorized to allow users to see the questions being addressed by Cochrane (through a Rapid Review or a normal Systematic Review); those being addressed by other systematic reviewers; and those questions, to the best of our knowledge, that are not yet being addressed.
This categorization facilitated decision making by Cochrane’s Editor in Chief, Karla Soares-Weiser, and Cochrane’s COVID-19 Working Group on the organization’s priority areas of work for the next phase of its response to the pandemic. The questions and issues to be addressed by Cochrane over the next six months were aligned with the taxonomy of the ‘COVID-19 Evidence Network to support Decision-making’ (COVID-END), of which Cochrane is a leading member. These priority questions to be addressed by Cochrane evidence cover:
- Clinical management: including questions related to screening and testing, drug treatment, critical care, prophylaxis, prognosis and the clinical management of pandemic related impacts on health
- Public health measures: including questions related to the prevention of infection, personal protection and the need to support healthcare workers; and
- Economic and social responses: including questions related to the social determinants of health and their impact on health outcomes, and the impact of COVID-19 on food poverty.
View or download a more detailed diagram setting out these priority questions.
“Identifying these priority health topics is a pivotal moment in defining Cochrane’s editorial priorities for the next six months, as we move from responding to immediate critical care to questions related to longer-term management of the COVID19 pandemic,” said Editor in Chief, Karla Soares-Weiser. “Using the vast expertise of clinicians and researchers across the Cochrane community and together with global decision-makers we have identified the key areas of COVID-19 evidence production Cochrane should invest in going forward. These questions and topics are where we think we can add most value, considering our capacity, expertise, and the evidence synthesis work already being done by other institutions worldwide. We have also prioritized those questions most in need of a ‘living systematic review’, constantly updating the review when new evidence becomes available.”
Each of Cochrane’s priority areas are being addressed through a range of planned outputs including Cochrane Rapid Reviews, new Cochrane ‘living’ Systematic Reviews and Network Meta-Analyses, all led by different consortia of Cochrane authors, Groups and Cochrane’s Central Editorial Team.
The Cochrane ‘Question Bank’ is also being made freely available to the global research community to help guide work on other critical synthesized evidence questions not being addressed by Cochrane. It will be updated periodically to help decision-makers review progress and activity; and highlight new questions and topics to be addressed in future.
This new phase of Cochrane’s response to the COVID-19 pandemic comes after two months of intense activity by the organization’s global community to curate, develop and publish evidence to support health policymakers, clinicians, practitioners and researchers in their work. Since the middle of March Cochrane has published:
- Six ‘Special Collections’ of Cochrane evidence relating to the prevention and treatment of COVID-19, containing 106 Cochrane Reviews and 67 Cochrane Clinical Answers (to support decision-making for health professionals). These Special Collections were developed based on World Health Organization (WHO) interim guidance and are updated in response to new information.
- Four Cochrane Rapid Reviews published with accompanying podcasts and six related Cochrane Clinical Answers.
- A full Cochrane Review on Personal Protective Equipment for healthcare staff.
- All of this evidence is translated in up to 12 other languages to promote its global accessibility and use; and Cochrane Reviews are also being made openly available on the Wiley Online Library along with other relevant Wiley content.
- A COVID-19 ‘Living Evidence Project’ presenting data on trials registered all over the world, as well as living evidence synthesis of results from these trials
- Cochrane’s 'COVID-19 Study Register’ of primary research studies, in consultation with WHO, which has become one of the largest and most sophisticated registers in the world.
- The April 2020 issue of the Cochrane Library App, featuring abridged versions of Cochrane Reviews relevant for COVID-19 (available from Google Play (Android devices) or the App Store (iPhone and iPad)).
- The Cochrane Library Journal Club (Issue #97), focusing on a Cochrane Review related to COVID-19 response preparation.
Cochrane provides high-quality, relevant, and up-to-date synthesized research evidence to inform health decisions. Find out more about how Cochrane is responding to the COVID-19 pandemic: https://www.cochrane.org/coronavirus-covid-19-cochrane-resources-and-news
Thursday, May 21, 2020
New independent study finds Cochrane’s transparency over reporting financial conflicts of interest is leading the way
A study published in BMJ Open this month, concludes “the percentage of recent Cochrane meta-analyses on the effects of drug interventions that transparently reported funding sources and trial author–industry financial ties and employment for included trials far exceeds reporting in other journals.” Transparency of funding sources is particularly important for drug trials as the body of evidence may be dominated by studies funded by the makers of the drugs being tested.
In 2012, more rigorous reporting standards for Cochrane Reviews were introduced, including the reporting of trial funding sources and author–industry financial conflicts of interest. Reporting of funding sources for some or all included trials has now improved from 30% in Cochrane reviews of drug trials (as concluded in 2012) to 84% in recently published Cochrane meta-analyses. Only 15% of non-Cochrane reviews reporting funding sources for included trials, according to the recent study.
“Cochrane has made tremendous strides in this area,” said Kimberly Turner, the first author of the study. “with far more transparent reporting than even the top-ranked medical journals” (see 2020 study). Brett Thombs, the study’s senior author, added, “Cochrane is a standard setter in evidence synthesis. We hope that Cochrane will continue to focus on improving transparency in its reviews and that this will influence others to do the same.”
Karla Soares-Weiser, Editor in Chief of the Cochrane Library, commented, “Research integrity is the foundation on which our credibility rests and whilst we are proud of the conclusions this study draws, we know we have more work to do. Transparency is critical for trust and we’re committed to pushing forward our policies around conflicts of interest. This study focused on transparency about financial conflicts of interest, however later this year we will be implementing our revised conflict of interest policy, which further strengthens our rules for minimizing conflicts of interest in our own reviews.”
Representatives of four Cochrane Centres in Europe have signed an open letter to the European Medicines Agency (EMA) initiated by the German Institute for Quality and Efficiency in Health Care (IQWIG).
The letter – which Cochrane Austria, Cochrane France, Cochrane Germany and Cochrane Ireland have signed – calls on the EMA to publish clinical study reports on all drugs and vaccines for COVID-19 in full and immediately on the date of marketing authorisation.
Clinical study reports (CSRs) are detailed study documents that pharmaceutical companies provide to regulators such as the EMA as part of the drug approval process. In these reports, which are often thousands of pages long, manufacturers document in detail their clinical studies on the efficacy and risks of new active ingredients. CSRs also contain details on the design, methods and results of the study, down to the level of anonymised data of individual study participants. CSRs are therefore by far the most comprehensive information about a clinical trial.
The open letter, addressed to EMA Executive Director Prof Guido Rasi, highlights how the international research community has joined forces to identify or develop, test and evaluate drugs and vaccines to combat the pandemic. It states: “To assess these products further and to accelerate the development of additional products, the fast and full public availability of the information submitted to regulators is of utmost importance. In recent years, the EMA has been a pioneer in data transparency among regulatory agencies. It is exactly this transparency that is currently needed”.
Jörg Meerpohl, who signed the letter as director of Cochrane Germany and the Institute for Evidence in Medicine at the University Hospital of Freiburg, said: “Clinical study reports contain all relevant data on a study. They can be an important data source for systematic reviews. That is why Cochrane has long been campaigning for access to these documents”.
“In the current pandemic, great hopes are placed on research and industry to develop rapidly effective drugs for the treatment of COVID-19 and safe vaccines against infection with the causative virus SARS-CoV-2. In order for clinical research on COVID-19 to be independently reviewed and evaluated, transparency is needed regarding planned and conducted studies and access to the detailed study results. This includes access for independent scientists to clinical study reports”.
The EMA has recently launched an accelerated approval procedure for the antiviral drug remdesivir.
Cochrane has submitted a statement to the 73rd World Health Assembly, which is taking place virtually this week (18 and 19 May).
The World Health Assembly (WHA) is the decision-making body of the World Health Organization (WHO) and is attended by representatives of all Member States. This year’s WHA focuses on the COVID-19 pandemic.
Our statement highlights the value of evidence-informed health policy and, given the large volume of COVID-19-related research underway, calls for Member States to ensure trial transparency and to support evidence synthesis.
The full statement is below:
The COVID-19 pandemic highlights the critical importance of evidence-informed global health policy. Governments, healthcare professionals and researchers around the world are seeking answers to questions related to the treatment of patients, and how best to protect healthcare workers and the public.
Cochrane is a global leader in the production of high-quality synthesized evidence to inform health decision making. We are working closely with WHO by producing rapid reviews to answer priority questions related to COVID-19, thus supporting the development of effective guidance, treatments and cost-efficient responses to the pandemic.
However, the volume and variable quality of COVID-19-related research being published represents a huge challenge to synthesize their results accurately. Cochrane has identified over 4,000 COVID-19 human studies already ongoing or published; and has launched and will maintain one of the largest and most sophisticated registries of COVID-19 studies as well as a living synthesis of COVID-19 study results which is informing the WHO’s ‘Research and Development Blueprint’. Cochrane is also producing relevant ‘living systematic reviews’ that allow for continuous updates as new studies become available.
In the coming years billions of dollars will be spent on COVID-19 clinical trials. But we know that many clinical trials are never registered or reported on: a phenomenon which is seriously hampering decision making on best available evidence. Now, more than ever, it is vital that WHO’s guidance on public disclosure of results from clinical trials is followed. Without accessible trial data, and proper synthesis and appraisal, it is certain that much of this global research investment will be wasted.
We call on WHO member states to support evidence-informed decision making by taking action to safeguard trial transparency; and to provide adequate funding for evidence synthesis given the challenges ahead.Monday, May 18, 2020
To help reduce the spread of COVID-19, workers in many countries have changed their usual work habits and are working from home where feasible. Home working often involves prolonged sitting and working at a computer.
This Special Collection, developed in collaboration with Cochrane Work, brings together Cochrane Reviews summarizing evidence for maintaining health and wellbeing when working from home due to the COVID-19 pandemic. It includes systematic reviews that evaluate the effects of interventions related to maintaining physical activity, optimizing the work environment, and preventing musculoskeletal and eye problems.
Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications
Older people are often prescribed multiple medications, which can be challenging to manage and may lead to under-use or over-use of medication or medication-taking errors.
Review authors asked, “What are the best ways to help older adults who have been prescribed multiple medications to use and take their medications”.
The review authors identified 50 studies, with 14,269 participants. Studies tested educational interventions, behavioural interventions, or both, to assess improve medication-taking ability or medication adherence, or both. All the studies compared the interventions to usual care; and six studies also compared the intervention to another intervention as well as usual care.
Examples of "behavioral interventions" are multi-compartment dose-administration aids, simplifying the medication regimen (e.g. reducing number of dosing times per day), motivational interviewing, ongoing follow-up/support. "Educational interventions" include medication counselling with or without a review of medications (e.g. at the time of hospital discharge, at the time of dispensing)
These could be delivered individually or in combination by pharmacists and/or nurses.
The review authors did not identify any studies that assessed educational or behavioural interventions alone for medication-taking ability. Five mixed intervention studies used different measures of medication-taking ability, so the review authors could not determine the effects.
Behavioural-only and mixed interventions may improve adherence, but the effects of educational-only interventions are uncertain.
Mixed interventions may reduce the number of emergency department visits or hospital admissions and may lead to little or no change in health-related quality of life. Educational interventions alone probably have little or no effect on emergency department or hospital admissions, or health-related quality of life. The effects of behavioural interventions alone on emergency department or hospital admissions and health-related quality of life are uncertain. The effects of behavioural, educational, or mixed interventions on mortality are unclear.
The studies identified were very different in terms of what interventions people received, where interventions were delivered, and how and when studies measured people’s medication-taking ability or adherence. Due to these differences and problems with how the trials were conducted, the review authors considered the quality of the evidence to be low or very low overall.
Further high-quality studies are necessary to identify the most effective way to improve medication-taking ability and medication adherence among older adults prescribed multiple medications.
The Governing Board is pleased to announce the appointment of Tracey Howe as Co-Chair and Karen Kelly as a new member
Governing Board Co-Chair: Tracey Howe
Cochrane’s Governing Board has appointed Professor Tracey Howe as its new Co-Chair from 1st September 2020. She will work alongside fellow Co-Chair Catherine Marshall, and replace Martin Burton, who will be stepping down in August, after serving six years on the Board, three as Co-Chair.
Professor Howe is Director of the Cochrane-Campbell Global Ageing Partnership and is based in Glasgow, UK. She was elected as a Governing Board member (Trustee) in July 2017, served as Treasurer from October 2018 to March 2019, and is a member of the Board’s Governance, and Finance Audit & Investment Committees.
Outside Cochrane, Tracey works with the World Health Organization on the decade of Healthy Ageing 2020-30 and has previously been involved on various committees of the National Institute for Clinical Excellence in England, and the Scottish Intercollegiate Guidelines Network. In addition, she has worked extensively with the Cochrane Consumer Network since 2003, and as a Cochrane author, editor and former Co-ordinating Editor. She has experience in public engagement and knowledge translation, championing the consumer voice in health care, disseminating research into practice and initiating, driving and delivering large-scale science communication to the public - including the achievement of a Guinness World Record for the largest hand hygiene lesson involving over 5,500 children, 60 primary schools and 160 student nurses in Glasgow.
Co-Chair, Catherine Marshall says: “Tracey has been an active member on Cochrane’s Governing Board and of organizations at all levels from local community initiatives through to European-based charities. Tracey has experience in leading international collaborative partnerships and these experiences will be a significant asset to Cochrane. I look forward to working with her as Co-Chair of the Governing Board from September 2020. The Board has greatly appreciated Martin Burton’s contribution as Co-Chair and will have time to recognize his valuable contribution in the coming months.”
Of her appointment, Tracey, says: “It is a great privilege and honor for me to be named as Co-Chair of the Board of Cochrane, which has such an incredible history and esteemed reputation. I am excited to work alongside Co-Chair Catherine Marshall to lead our talented and strategic-minded Board, senior management team and wider incredible global Cochrane community who have such strong skills and depth of experiences in producing and disseminating high-quality, relevant and up-to-date synthesized research evidence that informs health and health care.”
Governing Board member: Karen Kelly
The Board has also appointed Karen Kelly as a Trustee for Cochrane. Karen has had a successful career as an accountant and financial leader in the public sector and since leaving full time employment in 2012, has been developing her interests in a wider range of organizations through consultancy, training and non-executive roles. She currently holds three other board positions with a National Health Service board, a Further Education College, and a national charity. All these organizations are based in Scotland, and Karen is excited to add to her portfolio by joining Cochrane, with its much wider geographical reach.
Karen brings extensive experience in financial management, UK governance, and strategic planning to complement the diverse skillsets of other Board members. Her appointment is for three years, starting immediately. The Board is delighted to welcome her.
Members of the Governing Board can be contacted at firstname.lastname@example.orgThursday, May 14, 2020