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