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Updated: 9 hours 16 min ago

How accurate are routine laboratory tests for diagnosis of COVID-19?

Thu, 11/19/2020 - 13:10

What are routine laboratory tests?

Routine laboratory tests are blood tests that assess the health status of a patient. Tests include counts of different types of white blood cells (these help the body fight infection), and detection of markers (proteins) that indicate organ damage, and general inflammation. These tests are widely available and in some places they may be the only tests available for diagnosis of COVID-19.

What did the authors want to find out?

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, the standard test for COVID-19 is usually the RT-PCR test. In the RT-PCR, samples from the nose and throat are sent away for testing, usually to a large, central laboratory with specialist equipment. Other tests include imaging tests, like X-rays, which also require specialist equipment.

The authors of this review wanted to know whether routine laboratory tests were sufficiently accurate to diagnose COVID-19 in people with suspected COVID-19. They also wanted to know whether they were accurate enough to prioritize patients for different levels of treatment.

What did the author team do?

Authors searched for studies that assessed the accuracy of routine laboratory tests to diagnose COVID-19 compared with RT-PCR or other tests. Studies could be of any design and be set anywhere in the world. Studies could include participants of any age or sex, with suspected COVID-19, or use samples from people known to have – or not to have - COVID-19.

What authors found

The authors found 21 studies that looked at 67 different routine laboratory tests for COVID-19. Most of the studies looked at how accurately these tests diagnosed infection with the virus causing COVID-19. Four studies included both children and adults, 16 included only adults and one study only children. Seventeen studies were done in China, and one each in Iran, Italy, Taiwan and the USA. All studies took place in hospitals, except one that used samples from a database. Most studies used RT-PCR to confirm COVID-19 diagnosis.

Accuracy of tests is most often reported using ‘sensitivity’ and ‘specificity’. Sensitivity is the proportion of people with COVID-19 correctly detected by the test; specificity is the proportion of people without COVID-19 who are correctly identified by the test. The nearer sensitivity and specificity are to 100%, the better the test. A test to prioritize people for treatment would require a high sensitivity of more than 80%.

Where four or more studies evaluated a particular test, the authors of this review pooled their results and analyzed them together. Their analyses showed that only three of the tests had both sensitivity and specificity over 50%. Two of these were markers for general inflammation (increases in interleukin-6 and C-reactive protein). The third was for lymphocyte count decrease. Lymphocytes are a type of white blood cell where a low count might indicate infection.

How reliable are the results?

Confidence in the evidence from this review is low because the studies were different from each other, which made them difficult to compare. For example, some included very sick people, while some included people with hardly any COVID-19 symptoms. Also, the diagnosis of COVID-19 was confirmed in different ways: RT-PCR was sometimes used in combination with other tests.

Who do the results of this review apply to?

Routine laboratory tests can be issued by most healthcare facilities. However, these results are probably not representative of most clinical situations in which these tests are being used. Most studies included very sick people with high rates of COVID-19 virus infection of between 27% and 76%. In most primary healthcare facilities, this percentage will be lower.

What does this mean?

Routine laboratory tests cannot distinguish between COVID-19 and other diseases as the cause of infection, inflammation or tissue damage. None of the tests performed well enough to be a standalone diagnostic test for COVID-19 nor to prioritize patients for treatment. They will mainly be used to provide an overall picture about the health status of the patient. The final COVID-19 diagnosis has to be made based on other tests.

How up-to-date is this review?

The authors searched all COVID-19 studies up to 4 May 2020.

Thursday, November 19, 2020

Cochrane review has informed 20 sets of guidelines around the world

Wed, 11/18/2020 - 20:41

Cochrane Review: Early skin‐to‐skin contact for mothers and their healthy newborn infants

In 2016, Cochrane Pregnancy and Childbirth published a systematic review looking at if skin-to-skin contact improved breastfeeding rates and helped babies adjust to the outside world. They looked at the results of 46 studies which included almost 4000 mothers and their babies. Overall, their review supports the use of skin-to-skin to encourage breastfeeding. The evidence suggests that early skin-to-skin should be normal practice for healthy newborns including those born by caesarean and babies born early at 35 weeks or more. Even where skin-to-skin is possible only for a short time, it will still encourage successful breastfeeding one to four months post birth. Importantly, the findings of improved breastfeeding rates were found in diverse countries and among women of low and high socio-economic class. 

Listen to the lead author explain the results

Since publication, this review has informed 20 sets of guidelines around the world, with the World Health Organisation (WHO) referencing the review in their 2017 guidance for promoting and supporting breastfeeding. It has been translated into five languages.

Elizabeth Moore, Associate Professor of Nursing at Vanderbilt University School of Nursing and lead author of the review said:

"I have really been amazed at the impact that this Cochrane Review has had around the world. It started as just a gut feeling I had as a breastfeeding consultant over 20 years ago that placing mothers and babies together skin-to-skin right after birth would help them breastfeed more successfully. Since then, this profound, but simple intervention has spread throughout the world based on the evidence in this review.”

In the UK, NICE has used the evidence in their 2006 guidance, and the latest revision in 2015, with the recommendation that women have skin-to-skin contact with their babies after birth. The Royal College of Nursing, UNICEF and Public Health England have all cited the research to promote skin-to-skin contact after birth. As a result, a 2019 survey by the Care Quality Commission reported that 93% of women in England had skin-skin contact after birth.

In June 2020, the WHO stated that skin-to-skin contact and breastfeeding should still be encouraged for new mothers and their babies in cases of suspected or confirmed COVID-19. Early evidence suggests that the benefits of skin-to-skin and breastfeeding far outweigh any risks.

Wednesday, November 18, 2020

Featured Review: Physical interventions to interrupt or reduce the spread of respiratory viruses

Tue, 11/17/2020 - 16:58

An updated Cochrane review published today in the Cochrane Library summarizes randomized trial evidence about face masks, hand washing and physical distancing to interrupt or reduce the spread of respiratory viruses. The review will inform revised guidance due to be released by the World Health Organisation. 

Lisa Bero, Cochrane Public Health and Health Systems Senior Editor and an author on an Editorial published to accompany this review said, “The results of this review should be interpreted cautiously, and the uncertain findings should not be taken as evidence that these measures are not effective. Most of the trials looked at the effects of measures like face masks and hand washing on their own, however no single measure alone will be enough to reduce the spread of COVID-19. Public health decision makers need to consider all of the available evidence and are likely to act on uncertain evidence if the intervention has the potential to protect the health of large populations and it is unlikely to lead to very serious harm.” 

What are respiratory viruses? 

Respiratory viruses are viruses that infect the cells in your airways: nose, throat, and lungs. These infections can cause serious problems and affect normal breathing. They can cause flu (influenza), severe acute respiratory syndrome (SARS), and COVID-19.

How do respiratory viruses spread?

People infected with a respiratory virus spread virus particles into the air when they cough or sneeze. Other people become infected if they come into contact with these virus particles in the air or on surfaces on which they have landed. Respiratory viruses can spread quickly through a community, through populations and countries (causing epidemics), and around the world (causing pandemics).

How can we stop the spread of respiratory viruses?

Physical measures to try to stop respiratory viruses spreading between people include:

  • washing hands often;
  • not touching your eyes, nose, or mouth;
  • sneezing or coughing into your elbow;
  • wiping surfaces with disinfectant;
  • wearing masks, eye protection, gloves, and protective gowns;
  • avoiding contact with other people (isolation or quarantine);
  • keeping a certain distance away from other people (distancing); and
  • examining people entering a country for signs of infection (screening).

Why the authors did this Cochrane Review 

The authors of this review wanted to find out whether physical measures stop or slow the spread of respiratory viruses.

What did authors do?

The authors searched for studies that looked at physical measures to stop people catching a respiratory virus infection.

They were interested in how many people in the studies caught a respiratory virus infection, and whether the physical measures had any unwanted effects.

Search date: This is an update of a review first published in 2007. We included evidence published up to 1 April 2020.

What the authors found

Review authors identified 67 relevant studies. They took place in low-, middle-, and high-income countries worldwide: in hospitals, schools, homes, offices, childcare centres, and communities during non-epidemic influenza periods, the global H1N1 influenza pandemic in 2009, and epidemic influenza seasons up to 2016. No studies were conducted during the COVID-19 pandemic. The authors identified six ongoing, unpublished studies; three of them evaluate masks in COVID-19.

One study looked at quarantine, and none eye protection, gowns and gloves, or screening people when they entered a country.

The authors assessed the effects of:

  • medical or surgical masks;
  • N95/P2 respirators (close-fitting masks that filter the air breathed in, more commonly used by healthcare workers than the general public); and
  • hand hygiene (hand-washing and using hand sanitiser).

What are the results of the review?

Medical or surgical masks

Seven studies took place in the community, and two studies in healthcare workers. Compared with wearing no mask, wearing a mask may make little to no difference in how many people caught a flu-like illness (9 studies; 3507 people); and probably makes no difference in how many people have flu confirmed by a laboratory test (6 studies; 3005 people). Unwanted effects were rarely reported, but included discomfort.

N95/P2 respirators 

Four studies were in healthcare workers, and one small study was in the community. Compared with wearing medical or surgical masks, wearing N95/P2 respirators probably makes little to no difference in how many people have confirmed flu (5 studies; 8407 people); and may make little to no difference in how many people catch a flu-like illness (5 studies; 8407 people) or respiratory illness (3 studies; 7799 people). Unwanted effects were not well reported; discomfort was mentioned.

Hand hygiene

Following a hand hygiene programme may reduce the number of people who catch a respiratory or flu-like illness, or have confirmed flu, compared with people not following such a programme (16 studies; 61,372 people). Few studies measured unwanted effects; skin irritation in people using hand sanitiser was mentioned.

How reliable are these results?

The authors' confidence in these results is generally low for the subjective outcomes related to respiratory illness, but moderate for the more precisely defined laboratory-confirmed respiratory virus infection, related to masks and N95/P2 respirators. The results might change when further evidence becomes available. Relatively low numbers of people followed the guidance about wearing masks or about hand hygiene, which may have affected the results of the studies.

Key messages

We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses.

Hand hygiene programmes may help to slow the spread of respiratory viruses.

Friday, November 20, 2020

Cochrane Library Editorial: Policy makers must act on incomplete evidence in responding to COVID-19

Mon, 11/16/2020 - 18:25

Reducing the transmission of Coronavirus disease 2019 (COVID-19) is a global priority. Toward this end, public health officials and politicians across the world have been seeking scientific expertise to guide policy. In response, investigators have rushed to share new results on preprint servers, and journals have expedited editorial and peer review processes to publish them. The urgency to define the relevant knowledge base in preventing, diagnosing, and managing COVID-19 infection and its sequelae has required intense collaboration in evidence generation and synthesis, in order to provide public health officials with authoritative guidance.

A newly published Cochrane Library Editorial addresses how Cochrane has responded to the COVID-19 pandemic, what the limitations to COVID-19  evidence are, and suggestions on how policy makers can move forward with best available evidence. This Editorial publishes alongside the updated Cochrane Review 'Physical interventions to interrupt or reduce the spread of respiratory viruses'. 

Saturday, November 21, 2020

Featured Review: Cognitive behavioural therapy for anxiety in children and young people

Mon, 11/16/2020 - 12:14

Why is this review important?
Many children and young people experience problems with anxiety. Children and young people with anxiety disorders are more likely than their peers to have difficulty with friendships, family life, and school, and to develop mental health problems later in life. Therapies such as cognitive behavioural therapy (CBT) can help children and young people to overcome difficulties with anxiety by using new ways of thinking and facing their fears.

Who will be interested in this review?
Parents, children, and young people; people working in education and mental health services for children and young people; and general practitioners.

What questions does this review aim to answer?
This review updates and replaces previous Cochrane Reviews from 2005 and 2015, which showed that CBT is an effective treatment for children and young people with anxiety disorders.

This review aimed to answer the following questions:

  • Is CBT more effective than a waiting list or no treatment?
  • Is CBT more effective than other treatments and medication?
  • Does CBT help to reduce anxiety for children and young people in the longer term?
  • Are some types of CBT more effective than others? (e.g. individual versus group therapy)
  • Is CBT effective for specific groups? (e.g. children with autism)

Which studies were included in the review?
We searched the databases to find all studies of CBT for anxiety disorders in children and young people published up to October 2019. In order to be included in the review, studies had to be randomised controlled trials (a type of study in which participants are assigned to one of two or more treatment groups using a random method) and had to include young people under 19 years of age with an anxiety disorder diagnosis. We included 87 studies with a total of 5964 participants in the analysis.



What does the evidence from the review tell us?
We rated the overall quality of the evidence as 'moderate’ or 'low'. There is evidence that CBT is more effective than a waiting list or no treatment in reducing anxiety in children and young people, although the findings did vary across studies. There is no clear evidence that CBT is more effective than other treatments. A small number of studies looked at outcomes six months after CBT was given and showed that reductions in anxiety continued. We found no clear evidence that one way of providing CBT is more effective than another (e.g. in a group, longer treatments, with parents) or that CBT is more or less effective for any specific group of children (e.g. children with autism spectrum disorders).

What should happen next?
Future research should compare CBT to alternative treatments and medication; identify who does and does not benefit from CBT and what those who do not benefit need; establish how to make CBT more accessible; and give far more consideration to neglected populations, including children and young people from low‐ and middle‐income countries.

Monday, November 16, 2020

Cochrane statement to the 73rd World Health Assembly about the Decade of Healthy Ageing

Thu, 11/12/2020 - 20:05

Following a session in May, a resumed World Health Assembly is taking place virtually this week (9-14 November).

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.

Our statement pledges support for the Decade of Healthy Ageing and highlights some of the work that the Cochrane Campbell Global Ageing Partnership is undertaking to help strengthen the evidence base in this area.

The full statement is below:

COVID-19 has emphasized the critical importance of evidence-informed global health policy. Governments, healthcare professionals and researchers worldwide continue to seek answers to questions related to the treatment of patients, and how best to protect populations. The pandemic has disproportionately affected older people and has demonstrated the need for and importance of good quality data and evidence to support them.

Cochrane is a global leader in producing high-quality synthesized evidence to inform health decision making. We are working closely with WHO in response to the pandemic by producing rapid reviews and living systematic reviews to answer COVID-19-related priority questions, as well as launching and maintaining one of the largest and most sophisticated registries of COVID-19 studies and a living synthesis of COVID-19 study results. In the area of ageing, the Cochrane Campbell Global Ageing Partnership produces and widely disseminates high-quality, high-priority systematic reviews of all available evidence, identifies evidence gaps and develops methods for evidence synthesis related to ageing. These syntheses will enable informed decision-making and policy development aimed at improving the lives of older people, their families and communities. The impacts of the pandemic clearly show that this work is more crucial now than ever.

The Cochrane Campbell Global Ageing Partnership pledges its commitment to the Decade of Healthy Ageing. We are working with the WHO Ageing and Health team and as members of the International Consortium on Evidence and Metrics for Healthy Ageing. This consortium is playing a key role in strengthening data, research and innovation, generating impact for older people’s health and wellbeing. There are still major evidence gaps and the Decade of Healthy Ageing will allow us to focus on research and innovation for improving the lives and wellbeing of older people.

Thursday, November 12, 2020

Rapid research requires teamwork and methodological expertise – Cochrane praised in recent publication

Thu, 11/12/2020 - 18:52

‘A QuESt for speed: rapid qualitative evidence syntheses as a response to the COVID-19 pandemic’ published in BMC Systematic Review

In a recently published article, the research team of a Cochrane rapid qualitative evidence synthesis reflects on their experience and discuss the challenges they were faced with at each stage of the review.  The authors describe practical considerations and stress the level of methodological expertise and dedication needed to deliver a qualitative evidence synthesis rapidly and accurately during the COVID-19 pandemic.

Throughout the paper, the team praise the collaborative nature of Cochrane and its importance when working to extreme deadlines in a pandemic situation, as in the excepts below:

"…We highlight the broader team of supporters, including the editors, peer reviewers, translators, healthcare workers, end-user stakeholders, and the broader Cochrane community. The membership of our immediate team and the support we received from the wider community was critical in completing and publishing our review within this timeframe. The core team had worked together previously and this also enhanced our completion trajectory. The merits of conducting rapid research with people who recognise each other’s work ethic, skill sets and personalities receive almost no attention in the literature...

The generosity of everyone to answer this question played a role that cannot be underestimated. In addition, through the Cochrane structure, the team had access to an international network offering specialised methodological and practical support. Cochrane EPOC’s editorial team maintains high levels of QES expertise providing essential guidance for sections of the review, as well as experience in dissemination and end-user input. The Cochrane community was quickly able to identify peer reviewers and copy editors, who contributed within the timeline…."

Kayleigh Kew, Cochrane’s Senior Editor for Methods commented: “The rapid qualitative evidence synthesis described is a true success story. The quality achieved in COVID-19 rapid reviews with such an unforgiving timelines show what is possible when dedicated authors come together with Cochrane’s vast and experienced network of editors and experts. Reflections from Cochrane authors and contributors like those presented in this article help the organization to learn from what has been achieved to continue producing high-quality, relevant syntheses when they are needed most.”

Thursday, November 12, 2020

AHSM

Wed, 11/11/2020 - 21:15

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.

We spoke with Austin Chiang, MD, MPH, a founding member of the AHSM and the chief medical social media officer at Jefferson Health, in Philadelphia about AHSM and the role of social media is playing in disseminating health information. 

Hi Dr. Chiang, would you mind telling us a bit more about yourself? 
Sure! I am a gastroenterology and advanced/bariatric endoscopist by training and currently am an assistant professor of medicine, director of the endoscopic bariatric program, and chief medical social media officer at Jefferson Health in Philadelphia. I completed my undergraduate studies at Duke University, medical school at Columbia University, and internal medicine residency at Columbia, New York Presbyterian Hospital, as well. Thereafter, my gastroenterology and bariatric endoscopy training was completed at Brigham and Women's Hospital, and I received a master's in public health at the Harvard TH Chan School of Public Health. My final fellowship was completed at Jefferson, where I stayed on as faculty.

You sound busy! And you are a founding members of AHSM - how did that get started?
Well, after years of being on social media, many of my colleagues, mainly physicians on Instagram, started noticing concerning trends of people misrepresenting themselves as a health experts without the requisite training. This led to the #verifyhealthcare hashtag campaign, that brought the founders together and led us to consider many other concerning observations we had of health professionals on social media. We were also eager to share with other health professionals how many of us had managed to reach larger audiences by using social media productively.

What does AHSM do?
While many of us are driven by our desire to put forth accurate health information on social media, we are most passionate about helping health professionals use social media effectively and responsibly to meet patients where they are. Without an increased professional presence on social media, misinformation can be easily perpetuated and audiences misled. However, getting health professionals online also requires guidance and incentives. Social media is rapidly evolving and can be time consuming. We therefore felt the need to create a 501(c)(3) professional society to help legitimize social media in health and collaborate with institutions and organizations. In our inaugural year we held a two-day conference, had a co-branded course with YouTube about how to optimize one's experience on the platform, and worked with Cochrane on World Evidence-Based Healthcare Day!

You have 55.4K followers on Instagram and 316.3K on TicTok. But not everyone is convinced that social media is a great way to disseminate health evidence because it’s a ‘serious and complex’ topic. What do you think about this?
People of all age groups are spending more time than ever before on social media. The average time per day exceeds two hours per day on social media. Individuals and advertisers across sectors have capitalized on this usage to promote their services and products. Especially during the pandemic, there has been growing attention in health. Social media is not only a great way to distribute health knowledge, it is absolutely imperative in 2020. "Serious and complex" topics can impact everyone, and without trained individuals to interpret that information, medical misinformation could wreak havoc.

It's been helpful to get a bit of 'social media star' power behind Cochrane with your member's posts. How has it been working closely with Cochrane?
It's been great! Our AHSM members know Cochrane as the ‘gold standard’ in consolidating health evidence through systematic reviews and it's been exciting to share Cochrane evidence and evidence-based medicine principles directly with our lay audience. 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. The COVID-19 pandemic has underscored the importance of educating our audiences about evidence based healthcare and the high quality evidence that Cochrane provides.

What’s your advice to med students, clinicians and researchers, and scientists in healthcare that are thinking about using social media?
Take it a step at a time. It's ok to observe and reach out to people who you look up to for advice on social media. People who are active on social media are used to putting themselves out there and helping colleagues out. Also, think about your purpose and what you're hoping to achieve. This really dictates which platform is most suitable and what approach to take.

That's great advice. What do you think the benefits are to the creator and to the audience? 
The benefits are numerous to both. For the creator, you access the latest information in real time, you build valuable networks, build practices, and participate in riveting conversations. For the audience it may be knowledge and access to health professionals you otherwise might not have had, and opportunities to learn about treatments and trials that would otherwise remain unknown. 

We have an 'Early Career Professionals Cochrane Group' who have been especially keen on using social media. How do you think early career professionals can leverage social media?
It depends on how early is early. I think we all develop a different comfort level of when we decide we are "qualified" to educate and discuss about topics online. I think no matter what stage someone is at, there is value. Pre-med and medical students share important perspectives that can inspire those aspiring students behind them, while informing those more senior to them.

Thanks for speaking with us, Dr. Chiang! 

If you would like to learn more about AHSM:

If you would like to learn more about social media at Cochrane:

 

Thursday, November 12, 2020

Prof Tracey Howe appears in Decade of Healthy Ageing ‘Leaders Voices’ video alongside WHO and UN leadership

Mon, 11/09/2020 - 12:00

Professor Tracey Howe, Director of the Cochrane-Campbell Global Ageing Partnership and Co-Chair of the Cochrane Governing Board, has pledged support for the Decade of Healthy Ageing (2020-2030) in a video alongside António Guterres, UN Secretary-General; Dr Tedros Adhanom Ghebreyesus, WHO Director-General; Professor Klaus Schwab, Founder and Executive Chairman of the World Economic Forum; Dr Natalia Kanem, Executive Director United Nations Population Fund; the International Federation on Ageing; and HelpAge International.

The Decade of Healthy Ageing aims to bring together governments, civil society, international agencies, professionals, academia, the media, and the private sector to jointly take action in order to improve the lives of older people, their families, and the communities in which they live.

The Cochrane-Campbell Global Ageing Partnership has been actively supporting WHO in preparing for the Decade of Healthy Ageing, which is expected to formally launch via the United Nations in the coming months. We look forward to sharing the outputs of this collaboration in due course.

Tuesday, November 10, 2020

Supporting resilience and mental well-being in frontline healthcare professionals during and after a pandemic

Thu, 11/05/2020 - 12:10

What is the best way to support resilience and mental well-being in frontline healthcare professionals during and after a pandemic? What is ‘resilience’?

Working as a 'frontline' health or social care professional during a global disease pandemic, like COVID-19, can be very stressful. Over time, the negative effects of stress can lead to mental health problems such as depression and anxiety, which, in turn, may affect work, family and other social relationships. ‘Resilience’ is the ability to cope with the negative effects of stress and so avoid mental health problems and their wider effects. Healthcare providers can use various strategies (interventions) to support resilience and mental well-being in their frontline healthcare professionals. These could include work-based interventions, such as changing routines or improving equipment; or psychological support interventions, such as counselling.

What did the review authors want to find out?

Firstly, they wanted to know how successfully any interventions improved frontline health professionals’ resilience or mental well-being. Secondly, the authors wanted to know what made it easier (facilitators) or harder (barriers) to deliver these interventions.

Key message

The authors did not find any evidence that tells us about how well different strategies work at supporting the resilience and mental well-being of frontline workers. They found some limited evidence about things that might help successful delivery of interventions. Properly planned research studies to find out the best ways to support the resilience and mental well-being of health and social care workers are urgently required.

Lead author of this review Dr Alex Pollock explains, “It is clear that frontline healthcare workers have to deal with enormous stress when working in any infectious disease epidemic, and this clearly has a negative impact on their mental health. Despite this, there remains a lack of high quality research about how best to support the mental health of these workers. With the continuation of the COVID-19 pandemic there is an opportunity for carefully planned, well-conducted research to determine the best way to support the mental health of frontline workers - I really hope that these research studies are prioritised. While we found a lack of high quality research in this review, it is important to note that our focus was limited to evidence relating to healthcare professionals working during infectious disease epidemics / pandemics. It’s clear that we now need to expand the scope of this review and turn to evidence from other diseases and health crises. We also need to bring together evidence about how best to prepare people for frontline work. Finally, it’s important to remember that the majority of people who work at the frontline are not healthcare professionals, but are, for example, porters or cleaners. We need to make sure that future research addresses ways to support this wider workforce.”

What did the author team do?

They searched medical databases for any kind of study that investigated interventions designed to support resilience and mental well-being in healthcare professionals working at the front line during infectious disease outbreaks. The disease outbreaks had to be classified by the World Health Organization (WHO) as epidemics or pandemics and take place from the year 2002 onwards (the year before the severe acute respiratory syndrome (SARS) outbreak).

What did they find?

16 relevant studies were identified. These studies came from different disease outbreaks - two were from SARS; nine from Ebola; one from Middle East respiratory syndrome (MERS); and four from COVID-19. The studies mainly looked at workplace interventions that involved either psychological support (for example, counselling or seeing a psychologist) or work-based interventions (for example, giving training, or changing routines).

Objective 1: one study investigated how well an intervention worked. This study was carried out immediately after the Ebola outbreak, and investigated whether staff who were training to give other people (such as patients and their family members) 'psychological first aid' felt less ‘burnt out’. The authors had some concerns about the results that this study reported and about some of its methods. This means that confidence in the evidence is very low and the authors cannot say whether the intervention helped or not.

Objective 2: all 16 studies provided some evidence about barriers and facilitators to implement interventions. The author team found 17 main findings from these studies. They do not have high confidence in any of the findings and had moderate confidence in six findings and low to very low confidence in 11 findings.

The authors are moderately confident that the following two factors were barriers to implementation of an intervention: frontline workers, or the organisations in which they worked, not being fully aware of what they needed to support their mental well-being; and a lack of equipment, staff time or skills needed for an intervention. The authors are moderately confident that the following three factors were facilitators to implementation of an intervention: interventions that could be adapted for a local area; having effective communication, both formally within an organisation and informal or social networks; and having positive, safe and supportive learning environments for frontline healthcare professionals. The authors are moderately confident that the knowledge and beliefs that frontline healthcare professionals have about an intervention can either help or hinder implementation of the intervention.

Thursday, November 5, 2020

Managing Editor, Cochrane Gut satellite - UK

Tue, 11/03/2020 - 21:00

Hours: Full time (37.00 hours per week - 1.0 FTE)
Basis: Fixed term contract for 12 months
Grade: I (£44045 - £51034)
Closing Date: 17th November 2020
Interview Date: 9th December 2020

The  University of Central Lancashire - School of Medicine wishes to appoint a Managing Editor who will be based at UCLAN Preston campus but will be expected to work collaboratively with the wider study team internationally employing IT solutions to achieve this.  This role will involve the primary managing editor role for the Cochrane Gut group satellite in UCLAN. The group has a portfolio of 120 reviews, 40 protocols and 25 titles at present. This covers IBD management in adults and children, excluding microbiome focussed works. Additionally, the children’s functional bowel portfolio. Through collaboration with the Cochrane Gut group in Canada, we will also lead editorial for all reviews authored by their editors and vice versa, involving work on a wider Gut portfolio.

There will be a significant volume of research output and scholarly content to be produced by the post holder themselves, as well as facilitating the wider team. Expect 30-40 full reviews per annum to be completing editorial as a minimum during this period of rapid updating and reprioritisation, as well as 20-30 protocols, associated positions pieces, editorials and patient / servicer user materials. The post holder will have to work highly efficiently, communicating in a timely and effective manner with the CEs and colleagues. There will also likely be educational and dissemination activities with various stakeholders and patients on a regular basis.

With experience of systematic review work and specific Cochrane experience, you will have knowledge and understanding of the work of Cochrane Collaboration and the nature of systematic reviews. Experience of Cochrane editorial roles and dissemination and presentation of such works is also essential.

You will have postgraduate training in an appropriate field to at least Masters level, including epidemiology, public health and medical specialities. A PhD or Professional Doctorate qualification are not essential requirements, but would be desirable.

You must possess excellent communication skills; have an ability to work within a multidisciplinary team and show initiative and innovation. With a professional and flexible approach, you will have a commitment to the missions and values of the University.

Informal enquiries are welcomed - please contact Morris Gordon, Head of Professionalism and Careers, via email in the first instance mgordon@uclan.ac.uk.

Applicants need to meet all essential criteria on the person specification to be considered for interview. This position is based in Preston with travel required.

Please apply online via www.uclan.ac.uk/jobs or by contacting Human Resources on 01772 892324 and quoting the reference number. CVs will not be considered unless accompanied by a completed application form.

 

Tuesday, November 3, 2020 Category: Jobs

Cochrane Library Editorial: Prospective meta‐analyses and Cochrane's role in embracing next‐generation methodologies

Tue, 11/03/2020 - 16:27

An editorial was published on 30 October entitled "Prospective meta‐analyses and Cochrane's role in embracing next‐generation methodologies". Prospective meta-analysis (PMA) challenges the traditional approach to conducting a systematic review, including when and how the search is conducted and the role of trial authors, to minimise biases and maximise completeness and applicability. In the editorial, members of the Cochrane Prospective Meta-Analysis Methods Group describe the benefits of the approach and challenge Cochrane to find a balance in its systems and policies to accomodate next generation methods while maintaining quality and timeliness.

Tuesday, November 3, 2020

ExME, the Spanish-language Students 4 Best Evidence blog, launches today

Tue, 11/03/2020 - 12:50

Today, a group of Iberoamerican medical and other health professions students have launched Estudiantes por la Mejor Evidencia (ExME), a Spanish-language blog that hopes to be an international hub for promoting, sharing, and disseminating information about evidence-based healthcare. This initiative, which follows in the footsteps of its English-language counterpart Students for Best Evidence (S4BE), is supported by Cochrane and Cochrane Iberoamerica and aligns with their Knowledge Translation strategies. 

After more than a year of preparations, ExME has launched as a network of students interested in evidence-based health care and as a "community for students, by students". Its objective is to develop an interactive platform with the best, evidence-based training resources, thanks to the contributions of individual, Spanish-speaking students from around the world and the support of its collaborating institutions.

"We hope that ExME will be a place where we can discuss and debate -- through a process of continuous learning and constant innovation -- about the different concepts that are fundamental to the application of evidence-based practice," writes the inaugural blogpost by the members of the Coordinating Committee, which is led by Andrés Viteri, from UTE in Ecuador. They add, "We would also like for this to be a place to build community and connect with other students and working groups. So we hope that, through publications of reviews, interaction on social media, and the space for discussion that we are making available here, you can find many opportunities and projects."

For the launch of the blog, ExME has published four posts simultaneously, as well as the inaugural welcome post: 

  • Can electronic cigarettes help you quit smoking?
  • Treatments can do harm
  • Observational cohort studies: general concepts from biostatistics and clinical epidemiology
  •  The "Evidencias COVID-19" tool offers the best, one-click information about the pandemic in Spanish

These entries are the first posts in five sections that the blog will explore (Critical thinking, Fundamentals of evidence-based medicine, Clinical Practice, COVID-19, and Community for best evidence), which will be expanded over time. 

If you are a Spanish speaker, join the ExME community! 

Tuesday, November 3, 2020

Cochrane COVID-19 Podcasts

Fri, 10/30/2020 - 17:26

Cochrane is preparing a series of reviews to help decision makers with their response to COVID-19. Each Cochrane podcast offers a short summary of a recent Cochrane COVID-19 review from the authors themselves. They allow everyone from healthcare professionals to patients and families to hear the latest Cochrane evidence in under five minutes. 

Do blood thinners prevent people who are hospitalised with COVID-19 from developing blood clots?
In October 2020, we published the findings on the effects of anticoagulants and lead author, Ronald Flumignan from the Federal University of Sao Paulo in Brazil describes what they found in this podcast.

How effective is screening for COVID-19?
Screening programmes are in place for many conditions and the COVID-19 pandemic has led to discussions of whether people should be screened for SARS-CoV-2, which is the virus that causes COVID-19. A Cochrane rapid review from September 2020 looks at the evidence for universal screening and we asked lead author, Meera Viswanathan from RTI International in the USA to describe the findings in this podcast.

Is plasma from people who have recovered from COVID-19 an effective treatment for people with COVID-19?
In October 2020, we published our second update of the review of convalescent plasma and hyperimmune immunoglobulin and we asked its lead author, Khai Li Chai from Monash University in Australia, to tell us about the latest findings.

How accurate is chest imaging for diagnosing COVID-19?
We asked the lead author of the September 2020 review of the evidence on using imaging tests to diagnose the condition, Jean-Paul Salameh from The Ottawa Hospital Research Institute in Canada, to describe their findings in this podcast.

Does quarantine, alone or in combination with other public health measures, control coronavirus (COVID-19)?
In this podcast, lead author, Barbara Nussbaumer-Streit from Danube University Krems in Austria outlines the findings of the review of quarantine, which was originally requested by the World Health Organization and was first published in April, before being updated in September 2020.

Can travel-related control measures contain the spread of the COVID-19 pandemic?
In this podcast, lead author, Jake Burns from the University of Munich in Germany describes the findings of our review of the effects of travel-related control measures, which was published in September 2020.

Can symptoms and medical examination accurately diagnose COVID-19 disease?
Published in June 2020, this review examines the accuracy of using signs and symptoms to diagnose whether someone has the disease. We asked the lead author, Thomas Struyf from the KU Leuven in Belgium, to tell us why the review is needed and what they found.

 

You can view and search our entire catalogue of hundreds of podcasts or subscribe via iTunes for the latest updates.

 

Wednesday, November 4, 2020

Featured Review: Physical activity interventions for people with congenital heart disease

Wed, 10/28/2020 - 20:42

 Review question 

This review aimed to gather evidence for the use of any physical activity intervention for people with congenital heart disease. The authors of this review aimed to compare interventions including exercise training, physical activity promotion or lung training with no intervention (usual care). 

Background 

Congenital heart disease is the term used for a range of birth defects that affect how the heart works. People with congenital heart disease have reduced life expectancy, physical fitness and quality of life. However, due to better prenatal diagnoses, surgical procedures (often performed in the early years of life) and earlier interventions, the survival rate for those born with this disease has improved dramatically, such that most people will now live into adulthood. Exercise training and physical activity interventions are known to improve fitness, physical activity, survival and quality of life in healthy people, but it is not clear how effective these programmes are for people with long-term medical conditions. 

Study characteristics 

The review authors searched for studies in September 2019 and identified 15 studies involving 924 participants. The studies used three main types of interventions, including programmes designed to increase physical activity, aerobic fitness and health-related quality of life and compared physical activity intervention and control interventions in people with congenital heart disease. 

Key results 

The authors included 15 trials with 924 participants. Half of the participants were female. Of the 15 trials, 5 used a total of 500 young people (less than 18 years of age) and 10 trials used a total of 424 adult participants. The review authors found that physical fitness and physical activity may slightly increase but we are very uncertain about quality of life. There is currently no data to say if this small increase in fitness will result in fewer visits to the hospital. But there were no recorded deaths or serious events that were related to participation in physical activity. 

Quality of evidence 

Using a validated scientific approach (GRADE), the certainty in the evidence base was moderate for fitness, low for physical activity and very low for quality of life. Most outcomes were limited due to small study participant numbers and poor reporting of study details.

Wednesday, October 28, 2020

Featured Review: Mental health of refugees, asylum seekers, and internally displaced persons

Wed, 10/28/2020 - 11:05

Migrants who have been forced to leave their home, such as refugees, asylum seekers, and internally displaced persons (IDP), are likely to experience stressors which may lead to mental health problems. The efficacy of interventions for mental health promotion, prevention, and treatment may differ in this population. A recent systematic review from the Cochrane Common Mental Disorders group looked at this topic: 'An overview of systematic reviews on mental health promotion, prevention, and treatment of common mental disorders for refugees, asylum seekers, and internally displaced persons.'

Supported by the National Institute for Health Research via Cochrane Infrastructure funding to the Common Mental Disorders Cochrane Review Group and Phil Roberts from the University of York they present the findings in this video:



Wednesday, October 28, 2020

Founding member of Cochrane, Dr. Peter Tugwell, receives the 2020 CIHR Barer-Flood Prize

Tue, 10/27/2020 - 19:45

The Canadian Institutes of Health Research (CIHR) Barer-Flood Prize recognizes an exceptional researcher who has created a seminal body of work that has had a substantial impact on health services and policy research, policy, and/or care delivery.

Dr. Peter Tugwell is a Professor at the University of Ottawa in the Faculty of Medicine and the School of Epidemiology & Public Health, a Senior Scientist, and a practicing internist with a rheumatology practice. In 2001, Dr. Tugwell became Director for the Centre for Global Health at the Institute of Population Health and has built a research program and multidisciplinary team around his Canada Research Chair in Health Equity. Dr. Tugwell has been at the forefront of international initiatives working with patients, clinicians and guideline developers to ensure that medical treatments prescribed for musculoskeletal conditions are based on the most recent scientific evidence. In 2013, Governor General of Canada appointed Dr. Tugwell as an Officer of the Order of Canada. This appointment recognizes a lifetime of achievement and merit of a high degree. Dr. Tugwell was recognized for his contributions as an epidemiologist reducing global disparities in health care.

Dr. Tugwell’s history with Cochrane is long standing. He is founding member of Cochrane and a former Cochrane Steering Group member. He is the Founding Coordinating Editor of the Cochrane Musculoskeletal Review Group, Founding Co-convener of the Campbell and Cochrane Methods Equity group, and Senior Editor of the Cochrane Musculoskeletal, Oral, Skin, and Sensory Network

Cochrane and our extended community offers our warmest congratulations to Dr. Tugwell on his achievement.

Tuesday, October 27, 2020

Talking to parents about evidence-based healthcare and the work of Cochrane

Tue, 10/27/2020 - 17:57

To mark the recent World Evidence-based Healthcare Day, Registered Nurse Penny Blunden (BN, MNursAP) spoke to her 21,000 followers on @Sick.Happens in an Instagram Live about Cochrane work and the importance of good quality evidence. This chat was aimed about parents interested in health evidence – we caught up with her to ask her more.

Hi Penny, thanks for speaking with us. It’s great to see so many healthcare professionals on social media. What’s your background?
I am a Paediatric Registered Nurse with a Masters of Nursing. I have always had a passion for working with children, but since becoming a Mum myself, I realised how much ongoing support and education parents need when raising little humans.

Your handle on Instagram is @Sick.Happens. Can you tell us more about that? Why did you start Sick Happens?
I started Sick Happens after realising that parents don’t have this ongoing support and education. The only access they had to evidence-based health education surrounding the illnesses in children were in a time-restricted GP appointment, a chaotic Emergency visit or in a first-aid course. Although these services are critical, they don’t provide the education surrounding the somewhat inevitable bouts of sickness. The fevers, vomiting, breathing colds & flu’s, poo questions — the list is endless. So I founded Sick Happens to fill this gap.

Not everyone is convinced that social media is a great way to disseminate health evidence because it’s a ‘serious and complex’ topic. Why do you think Instagram an important platform for parents?
Instagram is critical in delivering health education because this is where parents are hanging out. This is where parents retreat to when they have 5 minutes spare from parenting. This is also where they are choosing to find advice and inspiration, whether it be home organisation, exercise, relationships or fashion. So I felt it was absolutely necessary to make sure practical, evidence-based education was intermingled within all of this information so that it is easily accessible.

We see that you are often sharing Cochrane evidence and talking about systematic reviews with your audience. How do you know about Cochrane? How do you use it?
I learnt about Cochrane when I was an undergraduate studying Nursing. We were taught about the importance of systematic reviews, and how to undertake effective research. Now I use Cochrane as my first starting point whenever I want to research a new topic. Why would you not go to the highest level of evidence available at the beginning of your researching journey?!

It's great that you are sharing that with your audience too. Do you think evidence-based medicine and related concepts is something that should be shared with parents?
Absolutely! Not everyone understands how to analyse and interpret data. Critically analysing evidence, and understanding how this evidence is applied to everyday decisions is a learnt skill — a skill that takes time and practice. This is why it is important to help parents learn how to research effectively, and learn how this evidence can impact their decisions.

You recently spoke to a representative from Cochrane on your Instagram Live. What do you think parents get from these over your more static content?
It was great to talk to someone from Cochrane in a casual way over a live chat. This format gives parents the opportunity to:

  • See the conversation play out in real time
  • Join in on the conversation
  • Think about a topic before it is sprung on them
  • Watch it back and ask questions later
  • Plus, they can pop their headphones in and listen whilst driving to work, feeding a baby, cleaning the house or going for a walk.

We’ll include the video below of your Instagram Live Chat. what things did you cover?
A lot in such a short chat! I was so lucky to talk to a representative from the Cochrane to help parents understand how to research effectively, how evidence impacts healthcare, and how to differentiate high quality evidence from opinion. We chatted about what Cochrane does, what are systematic reviews, how Cochrane works with patients and carers directly, and how to distinguish high quality evidence, and some of their resources, such as Cochrane Evidence Essentials. It was a lovely, casual chat and feedback from the parents was positive – they felt the Cochrane evidence was assessable and something they could use.  

Tuesday, October 27, 2020

Cochrane seeks - Software Developer

Mon, 10/26/2020 - 15:44

Specifications: Full Time, Permanent  
Salary: circa £55,000 p.a.
Location: Copenhagen, Denmark
Application Closing Date: Monday 9 November 2020

Are you passionate about quality software? Do you have a drive to make a difference for health care world-wide? We are a global, independent organization that strives to inform health-care decisions every day. We gather and summarize the best evidence from research to help doctors, nurses, patients, carers, researchers, funders, and policymakers. We do not accept commercial or conflicted funding, and work to minimize risk of bias, in order to generate authoritative and reliable information.

“Cochrane summarizes the findings so people making important decisions – you, your doctor, the people who write medical guidelines – can use unbiased information to make difficult choices without having to read every study out there…” Sifting the evidence, The Guardian, 14 September 2016

Our development team is located in Copenhagen and supports the process of creating systematic reviews through a web-based application. We are a group of motivated, mission-driven people who are energized by working together. We care about our users, taking pride in delivering features which both ensure the quality of Cochrane systematic reviews and make review production easier and more efficient.

As our new software developer, you'd contribute to the design and development of the web-based software used by thousands of Cochrane authors to produce systematic reviews, which includes tools and integrations for writing, statistical analysis, data management, study curation, data extraction, and more. Due to the fast-paced nature of our release cycle, the team interact frequently with users and other stakeholders.

Who we’re after
We are primarily looking for someone motivated by the mission of Cochrane and of our development team – that is, someone who cares about facilitating improved evidence-based healthcare decisions. We would consider it a bonus if you have specific knowledge of Cochrane, evidence-based health care, systematic reviews, and/or the global health sector.

On a technical level, we are looking for an analytical and efficient problem solver that can challenge our product and the processes around it, with experience in designing and building web applications in an Agile setting.

We work in English.

What you'd be doing

  • Working with a talented, passionate and collaborative agile team;
  • Designing, developing, testing, and maintaining our review production systems;
  • Achieving and maintaining a high level of automated test coverage;
  • Helping to drive continuous improvement of product, code, and processes.

How to apply

  • For further information on the role and how to apply, please click here
  • The deadline to receive your application is by 9th November 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
  • Please note Interviews to be held on 16th and 17th November 2020.

 

Monday, October 26, 2020 Category: Jobs

Cochrane and Malaysian Ministry of Health join together to provide full access to the Cochrane Library across the country

Wed, 10/21/2020 - 20:56

Cochrane is delighted to announce that the Cochrane Library is now freely available to health decision-makers across Malaysia.

Thanks to the successful partnership between Cochrane Malaysia, Wiley, and researchers from the National Institutes of Health within the Malaysian Ministry of Health, the world-renowned Cochrane Library launches across the country, making it possible for decision-makers to use evidence to improve health decisions and expand evidence-based treatment in the Malaysian national healthcare system.

Cochrane is a global independent network of health practitioners, researchers, patient advocates and others in 140 countries working together to produce credible and accessible health information in the form of Cochrane systematic reviews and other evidence-based content and resources. This health information is published on the Cochrane Library

Cochrane Malaysia was officially formed as a branch of the Australasian Cochrane Centre in September 2014. It is a network coordinated by RCSI & UCD Malaysia Campus and comprising four other institutions: Institute for Medical Research, Melaka-Manipal Medical College, University of Malaya and Universiti Sains Malaysia. Its work advocates for the evidence-informed health care across the country holding training events, mentoring authors, establishing close links with the Ministry of Health, and building up a network of individuals able to provide local support for the publication of Cochrane systematic reviews.

Professor Jacqueline Ho, Co-Director of Cochrane Malaysia at the RCSI & UCD Malaysia campus, said of this announcement: “We sincerely thank the Ministry of Health of Malaysia for providing national access to the Cochrane Library. National access to Cochrane Reviews has been the priority of Cochrane Malaysia since we started in 2014, and it is gratifying that it has finally happened. To progress as a Nation, Malaysia needs to have access to the best available research evidence in order to make the right healthcare policy and clinical practice decisions and to ensure that healthcare money is spent on treatments that are known to be beneficial. Access to the Cochrane Library is a big step in this direction.”

Director-General of Health in Malaysia, Tan Sri Datuk Seri Dr Noor Hisham Abdullah, said, “I am extremely happy that we are able to provide The Cochrane Library across the nation. As one of Cochrane Malaysia’s affiliate sites, MOH is extremely proud that we are progressing in providing the best research evidence for the best healthcare decision making. This provision comes at a very apt timing for use in our health care. I would like to congratulate NIH, Malaysia and all researchers for their dedication towards providing evidence from the Cochrane Library and continuous training for MOH, especially, and Malaysia generally.”

Professor Dr. Shaiful Bahari Ismail, Dean of the Medical School at Universiti Sains Malaysia, (USM), commented: “I strongly applaud a great move from our Ministry of Health to ensure free access to the Cochrane Library in Malaysia. USM has taken a leadership role in Cochrane Malaysia’s activities and systematic review process since 2004, with authorship of multiple reviews and organization of regular training courses. We are one of the official affiliates in Malaysia. In the early years, USM organized national meetings with all Malaysian medical schools to incorporate evidence-based medicine in the undergraduate medical curriculum. This was done in collaboration with the international SEA-ORCHID project. Among the pioneers that brought these important activities to USM include Prof. Hans Van Rostenberghe, Prof. Che Anuar Che Yaacob and Prof. Norhayati Mohd Nor. 

The move towards universal access to Cochrane will not only enhance in major ways our academic research but also will contribute to a more effective teaching and subsequently a better service to the patients. Community outreach programs will surely be facilitated too. I feel it is truly a great day for evidence-based medicine in Malaysia.”

Professor Dr. Moy Foong Ming, Coordinator of the University of Malaya site, reacted to this announcement: “As one of the members from the Cochrane Malaysia Coordinating Group, we are proud and grateful to note that the National Institutes of Health, Ministry of Health has successfully subscribed to the Cochrane National License. With this, all Malaysians and importantly for us, the University of Malaya’s students and staff get access to all full text under the Cochrane Library for free download. This will provide up to date evidence for clinical practice as well as research.”

Cochrane’s Chief Executive Officer, Mark Wilson, thanked the Malaysian Ministry of Health for arranging this agreement. He said: “I am delighted to hear this news – the exceptional efforts from the Cochrane Malaysia team mean that, now, everyone can access the high quality, trusted health information within the Cochrane Library from anywhere in the country. We are hopeful that Cochrane evidence will now inform more decisions made by policy makers, health practitioners, researchers and patients. Many of our Cochrane Malaysia researchers and clinicians are leaders in the field, and with the expertise they bring and new expanded access to the Cochrane Library, I know they will further our mission of delivering trusted evidence into health policy and clinical decision-making across Malaysia.”

Wednesday, October 21, 2020

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