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Updated: 4 hours 31 min ago

Cochrane Rapid Review examines travel-related control measures to contain the COVID-19 pandemic

Thu, 09/10/2020 - 18:04

 Can travel-related control measures contain the spread of the COVID-19 pandemic?

What are travel-related control measures?

To contain the spread of COVID-19, numerous countries have implemented control measures related to international travel. These include:

  • complete closure of borders (i.e. a total ban on any border crossings);
  • partial travel restrictions (e.g. restrictions on air travel only, or restrictions on travellers from certain countries);
  • entry or exit screening (e.g. when travellers are asked about symptoms, examined physically, or tested for infection when leaving or entering a country);
  • quarantine of travellers (e.g. when travellers have to stay at home or at a specific place for some time after crossing a border).

Some countries implemented similar travel-related control measures during the recent outbreaks of two related diseases, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).

What did the authors want to find out?

The authors wanted to find out how effective travel-related control measures are in containing the COVID-19 pandemic. They also wanted to know about the costs of the measures and what effect they have on healthcare and other resource use, as well as potential negative effects, such as feeling isolated.

What the authors did

The authors searched for studies on the effects of travel-related control measures on the spread of COVID-19, as well as on SARS and MERS to provide supporting information. Studies had to report how many cases (people with infection) the measures prevented or detected, and whether the measures changed the course of the epidemic. Studies could include people of any age, anywhere. They could be of any design including studies that used ‘real-life’ data (observational studies) or hypothetical data from computer-generated simulations (modelling studies).

Authors included studies published up to 26 June 2020.

What the authors found

The authors of this review found 25 studies on COVID-19, 10 on SARS and one on both SARS and MERS. Studies took place across the world except for Africa and the eastern Mediterranean.

Twelve studies (11 modelling studies, 1 observational study) on COVID-19 found that restricting cross-border travel at the beginning of an outbreak may reduce new cases by a minimum of 26% to a maximum of 90%, may reduce the number of deaths, may reduce the time to an outbreak by between 2 to 26 days, and may reduce the spread and risk of an outbreak. There was also a reduction in imported or exported cases and in growth of the epidemic.

The authors found 12 studies (11 modelling studies, 6 observational studies) on entry or exit screening, with and without quarantine, to contain the spread of COVID-19. Based on data from three modelling studies, there may be a delay in the time to an outbreak, and between 10% to 53% of infected travellers would be detected. However, the results from the observational studies varied considerably, and the authors are uncertain about the proportion of people identified accurately as having COVID-19 from these studies.

Only one modelling study examined quarantine measures for COVID-19. It found fewer new cases due to imported cases where 14-day quarantine was in place.

How reliable are these results?

The authors' confidence in these results is limited for several reasons. Most studies were not based on real-life epidemics but on mathematical predictions. Their results depended on the assumptions that they made, not on real-life data. Also, the studies were very different from each other and their results would probably vary according to the stage of the epidemic, the amount of cross-border travel, other measures undertaken locally, and the extent of implementation and enforcement. Results of entry and exit screening studies might vary according to the screening method used and the level of infection among travellers. Also, some studies were published as ‘preprints’, which means they did not undergo the rigorous checks of most peer-reviewed studies.

What this means

Overall, travel-related control measures may help to limit the spread of disease across national borders. Cross-border travel restrictions are probably more effective than entry and exit screening. Screening is likely to be more effective if combined with other measures, such as quarantine and observation. The authors of this review found very little information on travel-related quarantine as a stand-alone measure and no information on costs or negative effects.

Lead author Jacob Burns (Ludwig-Maximilians-University, Munich, Germany) said: “Travel-related control measures are not implemented in a vacuum, and their impact will be influenced by other factors, like the stage of the pandemic, whether community transmission has been established, whether other measures like physical distancing and wearing of facemasks have been implemented. The studies included in our review rarely investigated these aspects.”  

Wednesday, September 16, 2020

Producing Evidence: Goal 1 of Strategy to 2020

Thu, 09/10/2020 - 11:38

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 1 of Strategy to 2020 gets to the heart of Cochrane’s work: To produce high-quality, relevant, up-to-date systematic reviews, and other synthesized research evidence to inform health decision making.

Watch the video below to learn about how Cochrane has innovated and progressed toward Goal 1 during the past seven years:

We are now developing a new strategy for 2021 onwards, and we want to hear from you! The draft plan is available for your review and comment, with your feedback having the potential to directly contribute to changes before it’s finalized. Let’s collaborate to define Cochrane’s new strategic priorities. 

Watch video Strategy to 2020: Years of transformation

Thursday, September 10, 2020

Featured Reviews: Behavioural activation therapy for depression

Wed, 09/09/2020 - 17:40

How well does behavioural activation therapy work for depression in adults?  And what about the effects of this treatment on depression for adults with long‐term physical conditions? Two new Cochrane systematic reviews look at the available evidence.

Depression is a common mental health problem. It can cause a persistent feeling of sadness and loss of interest in people, activities, and things that were once enjoyable. Treatments for depression include psychological therapies (talking therapies). Two reviews recently published by Cochrane Common Mental Disorders focus on a type of psychological therapy called behavioural activation.

Behavioural activation encourages a person to develop or get back into activities which are meaningful to them. The therapy involves scheduling activities and monitoring behaviours and looking at specific situations where changing these behaviours and activities may be helpful. A therapist may support people in person, over the phone, or online, usually over multiple sessions.


 Behavioural activation is increasingly receiving attention as an intervention which may require fewer resources and less specialist training than other treatments for depression. This could make it easier to implement in a wide range of settings, including low- and middle-income countries and other settings with fewer specialists available to deliver treatments. It is important that the implementation of behavioural activation in practice is supported by up-to-date evidence.

Systematic review: Behavioural activation therapy for depression in adults

The first review published assessed whether behavioural activation can be an effective and acceptable treatment to offer to people with depression. Fifty-three studies were included.

The review found that behavioural activation may treat depression better than receiving usual care or humanistic therapy.

 It was uncertain whether behavioural activation worked better than medication, being on a waiting list, or receiving a range of other psychological therapies. There was no evidence available comparing behavioural activation to no treatment, placebo treatment, and integrative therapies.

Authors found no differences in the efficacy of behavioural activation compared with cognitive-behavioural therapy (CBT), third-wave CBT, or psychodynamic therapy.

For most comparators, authors found no differences with behavioural activation in terms of the acceptability of treatments, with the exception that behavioural activation is probably less acceptable to people than usual care (participants receiving behavioural activation were more likely to drop out of the studies).

 Lead author, Eleonora Uphoff from the Cochrane Common Mental Disorders Group based at the University of York in the UK to tell us about the findings. 

It was concluded that Behavioural activation may be an effective and acceptable treatment for depression in adults. It could be a suitable alternative to existing established treatments such as CBT. Offering this therapy in practice would give people with depression greater treatment choice, and different formats and types of delivery could be explored to meet the demand for mental health support.

The authors had limited confidence in the findings due to concerns about the certainty of the evidence. Most findings were short‐term, meaning that we cannot be sure behavioural activation would be helpful to people with depression in the longer term.


What about people with depression who also have long-term physical health conditions? 

 In reality many people have more than one health condition. For example, it is common for people with a mental health condition to also suffer from cardiovascular disease, diabetes, cancer, or chronic respiratory conditions.

These long-term physical conditions can impact on mental health, and mental health problems can affect how people cope with a physical condition. Given the complex relationships between mental and physical health, mental health treatments may work differently for people who do and do not suffer from long-term physical conditions. This is why Cochrane Common Mental Disorders is interested in mental health interventions for people with both mental and physical health conditions.

Systematic Review: Behavioural activation therapy for depression in adults with long‐term physical conditions

The second review asked how well behavioural activation treats depression in adults with long-term physical conditions. In this review, far less evidence was found. The review included only two studies; one of people recovering from stroke and the other of women with breast cancer. Behavioural activation was found to be more effective than comparators ‘treatment as usual’ and problem-solving therapy in the short term and medium term. However, these results were imprecise and effects were reduced in the longer term. When looking at depression symptoms, no difference was found.

Future directions for Cochrane Common Mental Disorders

It is important that we learn more about how behavioural activation works for different groups of people, such as adults with long-term physical conditions. Cochrane Common Mental Disorders is working on a number of reviews which assess the evidence on mental health interventions for people with physical conditions such as diabetes, and other specific populations and settings. There is a focus on involuntary migrants including children in collaboration with Cochrane Global Mental Health (CGMH). Together with the Cochrane EPOC group and CGMH we are working on reviews of mental health interventions for people living in low- and middle-income countries.

Keep an eye out for these and other reviews from the group, which will be available through the Cochrane Library. Follow @Cochrane_CCMD on Twitter if you would like to be the first to find out!

Wednesday, September 9, 2020

Cochrane Heart hosts an Author in Residence

Tue, 09/08/2020 - 19:11

Cochrane Heart Author in Residence: Mehul Srivastava

From September 2019 to January 2020, Cochrane Heart hosted Dr Mehul Srivastava, an honorary research fellow with University College London and Emergency Medicine trainee in Melbourne Australia, as an Author in Residence at the Cochrane Heart office in Central London.

During her residency she visited the office weekly to learn more from the team about the different aspects of authoring a Cochrane Systematic Review.

In this interview we ask her about the benefits of the experience, how it has helped her ongoing work as a clinician and a researcher, and her advice for anyone considering becoming an Author in Residence with Cochrane Heart.

Read the transcript 

Tuesday, September 8, 2020

Cochrane seeks Community Support Officer

Tue, 09/08/2020 - 08:46
  • Specifications: Permanent contract
  • Hours: Full time (1.0 FTE)
  • Salary: £30,000
  • Location: Flexible, (anywhere in the world), remote working
  • Application closing date: 20 September 2020 (midnight GMT)

This role is an exciting opportunity to use your communication and problem-solving skills to make a difference in the field of health care research.  

As Community Support Officer you will be joining Cochrane’s Community Support team. We are the first point of contact for the international Cochrane community, providing a timely and coordinated user support service. We resolve queries covering a broad range of areas including Cochrane Account login, Cochrane review software, membership, training, websites, sales and research. Community Support Officers are the day-to-day face of the team, answering the majority of queries and escalating complex enquiries appropriately.

Community Support sits within the People Services department in Cochrane’s Central Executive. The department provides all people-focused services within Cochrane, including inclusive learning programmes, platforms to enable participation in diverse Cochrane activities, human resources, consumer engagement and a wide range of internal and public-facing support services.

We are looking for a self-motivated and highly organised individual who is able to work effectively and collaboratively with a diverse range of contacts across the world.  The successful candidate will also have:

  • Experience in providing excellent user support, including excellent communication skills; a courteous, professional manner; and the ability to provide clear and accurate information to users.
  • Proactive and flexible approach to learning new systems to provide the best possible user support.
  • Experience with software and systems related to user support and communications, such as HappyFox, Jira, SugarCRM and MailChimp.
  • Excellent English-language communication skills (both verbal and written).
  • Experience in communicating technical content, tailoring standard communications to individual requirements, and working with people from a variety of cultural and linguistic backgrounds.
  • Attention to detail to ensure that community members always receive accurate information.
  • Experience in working collaboratively within complex organisations, including diverse and geographically-dispersed staff, collaborator and stakeholder groups across different time zones.
  • Self-motivated and results-oriented, with excellent organisation and time management skills, including the ability to work to deadlines as part of an interdependent team working remotely.
  • Familiarity with and commitment to Cochrane’s mission and values.
  • Openness to continuous professional development and training.

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

For further information on the role and how to apply, please click here.  The deadline to receive your application is by 20th September 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.

  • Deadline for applications: Sunday 20 September 2020 (12 midnight GMT)
  • Interviews to be held on: Friday 25 September 2020 (times to be confirmed)

Tuesday, September 8, 2020 Category: Jobs

Featured Review: Taxation of the fat content of foods for reducing their consumption and preventing obesity or other adverse health outcomes

Mon, 09/07/2020 - 19:05

Does a tax on the fat content of foods reduce obesity and help people to eat less fat and less saturated fat?

What is obesity?

Body mass index (BMI) is usually a useful measure to show whether people are a healthy weight for their height. A BMI of 18 to 25 shows a healthy weight, a BMI over 25 is considered overweight, and a BMI over 30 shows obesity.

Obesity is generally caused by consuming more energy (calories) than you burn off through physical activity or exercise. The body stores the excess energy as fat.

Obesity can lead to serious and life-threatening conditions, including type 2 diabetes, coronary heart disease, some types of cancer (such as breast cancer and bowel cancer), and stroke. Obesity can also affect people's quality of life (well-being).

What are fats?

Fat is essential to a healthy, balanced diet. Fats help the body to absorb some vitamins, and are a source of some fatty acids that the body cannot make. The main types of fat in foods are:

  • saturated (mostly from animal products, such as meat, cow's milk, cheese, cream, and butter); and
  • unsaturated (mostly found in oils from plants and fish).

Health guidelines usually recommend that people should:

  • reduce the overall amount of fat they eat;
  • limit the amount of saturated fats they eat; and
  • eat unsaturated fats instead of saturated fats.

Why we did this Cochrane Review

Rates of overweight and obesity are increasing around the world and are a major public health issue. We wanted to know whether increasing the prices of foods that have a lot of fats or saturated fats could put people off eating them, and reduce obesity.

What did we do?

We searched for studies that looked at the effects of a tax on the fat content of foods. We were interested in how a tax affected the:

  • total amount of fat, and saturated fats eaten;
  • total calories eaten;
  • calories eaten from all fats and saturated fats; and
  • rates of overweight and obesity.

Search date:

We included evidence published up to September 2019.

What we found

We found two studies from Denmark, conducted during 2011 to 2012. One looked at how a tax on some high-fat foods affected household demand for them; the other looked at information on supermarket sales for certain high-fat foods (minced beef, cream, and sour cream). They compared their results with data from before the tax started.

Both studies looked at a small number of foods that people bought, but not what foods people ate. They didn't measure how much total fat or saturated fat were eaten.

What are the results of our review?

If the amount of foods bought reflected the amount of foods eaten, then taxing the fat content of certain foods:

  • might reduce the total amount of fats eaten by 41.8 grams a week for each person in a household, in one study of 2000 households; and
  • might reduce the amount of saturated fats eaten (in minced beef and cream), in one study of 1293 supermarkets.

No studies measured the effect of taxing the fat content of foods on calories eaten, on obesity or overweight, or on total food sales.

How reliable are these results?

We are not confident in the results because the evidence is only from two studies; and these studies only measured a small number of foods bought, and did not measure foods eaten. One study did not report statistics about the accuracy of its results.

The results were from observational studies, in which researchers observe the effect of a factor (such as taxation) without trying to change who does, or does not, experience it. Observational studies do not give as reliable evidence as randomized controlled studies, in which the treatments people receive are decided at random.


We did not find enough reliable evidence to find out whether a tax on the fat content of foods resulted in people eating less fat, or less saturated fat.

We did not find any evidence about how a tax on the fat content of foods affected obesity or overweight.

The results of our review will change when further evidence becomes available.

Discussing the findings of this review, lead author Stefan Lhachimi said, “A tax on saturated fats could be in principle a good approach to reduce the consumption of so-called junk foods, a group of food products which is fiendishly tricky to define in legal terms. By taxing a main and unhealthy component of junk foods, i.e. saturated fat, consumption could be discouraged.” He continued, “The Danish fat tax is a lost opportunity. As an active researcher it is sad to see that the accountable authorities did not implement a thorough prospective evaluation of this game-changing policy initiative.”

Friday, September 11, 2020

Cochrane International Mobility - Israel Júnior Borges do Nascimento

Wed, 09/02/2020 - 14:45

Cochrane is made up of 11,000 members and over 67,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Getting involved in Cochrane’s work means becoming part of a global community. The Cochrane International Mobility programme connects successful applicants with a placement in a host Cochrane Group, learning more about the production, use, and knowledge translation of Cochrane reviews. The prgramme offers opportunities for learning and training not only for participants but also for host staff.

In this series, we profile those that have participated in the Cochrane International Mobility Program and learn more about their experiences.

Name: Israel Júnior Borges do Nascimento
Location: Belo Horizonte, Brazil
Cochrane International Mobility location: Cochrane Swedenand Cochrane Croatia

How did you first learn about Cochrane?
I first heard about Cochrane when my current coordinator (and source of inspiration, Dr. Milena Soriano) advised me to read the Cochrane Handbook for systematic reviews and meta-analysis. At that time, I was extremely focused on applying for a PhD position at my university. After several more months of research, I went to São Paulo (thanks for Dr. Alvato Attalah's support) to learn more about Cochrane and its methodology in a three-days intensive workshop. Since then, I simply fell in love with Cochrane.

What was your experience with Cochrane International Mobility?
My experience with the Cochrane International Mobility Program was not only amazing, but was extraordinarily strengthened. I was supposed to go only to Sweden, but for whatever reasons (and I believe sensible and spiritual reasons), I also had the opportunity to enjoy and to learn from the outstanding group in Croatia.

What are you doing now in relation to your Cochrane International Mobility experience?
At present I am working with Dr. Matteo in two systematic reviews neonatology-related. It has been a challenge since I did not have any prior experience with the topic. Dr. Matteo has always been amazingly kind and caring after my stay in Sweden. Moreover, I have been working on more methodological projects with Cochrane Croatia (with Dr. Tina and Dr. Irena).

Do you have any words of advice to anyone conserving a Cochrane International Mobility experience?
I actually and literally have so many words of advice for people who love research and love to experience daily challenges. But mostly important, if you really want to enhance personal and professional skills, try to consider the Cochrane International Mobility Program. Cochrane is different in a way that it accepts all sorts of "difference and singularities". Cochrane members believe in and support you, day-in day-out, not just for a week, not just for a month, but for years; and I am firmly convinced that they will work really hard, to make the future you want and believe a reality.



Thursday, September 10, 2020

Five Cochrane Pregnancy and Childbirth reviews inform WHO recommendations on drug treatment for non-severe hypertension in pregnancy

Tue, 09/01/2020 - 18:09

WHO recommendations on drug treatment for non-severe hypertension in pregnancy

Cochrane has been a non-governmental organization in official relations with the World Health Organization (WHO) since 2011. WHO develops global health guidelines, which are of a high methodological quality and are developed through a transparent, evidence-based decision-making process. Ensuring there is an appropriate use of evidence within these guidelines, represents one of the core functions of WHO.

WHO has recently released recommendations on drug treatment for non-severe hypertension in pregnancy. The primary audience of this recommendation includes health professionals who are responsible for developing national and local health protocols (particularly those related to pre-eclampsia and eclampsia, and nutrition for non-pregnant and pregnant women and adolescent girls), and those directly providing care to pregnant women and their newborns, including midwives, nurses, general medical practitioners, obstetricians, managers of maternal and child health programmes, and relevant staff in ministries of health, in all settings. It aims to help in increasing capacity in countries to respond to their needs on interventions before and/or early in pregnancy to prevent the risk of pre-eclampsia during pregnancy, and to prioritize essential actions in national health policies, strategies and plans.

Cochrane is proud to have evidence from five systematic reviews from Cochrane Pregnancy and Childbirth contribute to these recommendations. 

Tuesday, September 1, 2020

Featured Review: Oxygen therapy in adult intensive care patients with acute respiratory distress syndrome

Mon, 08/31/2020 - 22:00

Approaches to guiding oxygen therapy in adult intensive care patients with acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is a very severe breathing problem with a high mortality rate (chance of dying). It has many potential causes, including viral infections such as COVID-19, and there are no specific treatments for it except for giving patients oxygen via a ventilator (artificial breathing machine) on an intensive care unit, often for long periods of time. However, large amounts of oxygen (either a high concentration of oxygen or oxygen administered for a long period of time) are known to increase harm due to other illnesses (e.g. heart attack or stroke).

The review authors wanted to know whether patients with severe lung problems (ARDS) would do better (including less chance of dying) if they received higher or lower amounts of oxygen whilst they were on a ventilator in intensive care.

The team searched major medical databases up to 15 May 2020 for clinical trials studying oxygen use in adult patients with ARDS in intensive care units. They only searched for studies with the sickest patients, that is those who needed help with their breathing through a breathing tube that was connected to an artificial breathing machine. They did not restrict the search by language of publication. In addition to extracting and analysing the data from any studies that met these criteria, they also assessed the risk of bias (fairness) and the certainty (confidence) of the findings.

The authors included one study (205 participants) in the review. Patients with ARDS and receiving oxygen through a breathing tube in an intensive care unit may have a higher chance of death if they receive lower amounts of oxygen compared to receiving much higher amounts of oxygen, but the evidence is very uncertain. Confidence in the findings is very low as data were only available from one study that only had a small number of participants and was stopped earlier than anticipated because of safety concerns. The authors are therefore unable to definitively say whether giving more or less oxygen to ARDS patients is helpful.

Tuesday, September 1, 2020

Featured Review: Psychological therapies for the management of chronic pain (excluding headache) in adults

Fri, 08/28/2020 - 22:11

Many people experience pain that lasts more than three months that is neither cancer‐related nor a headache. The search for a diagnosis and pain relief is often long and can be discouraging.  In this interview, lead author of the recently updated Cochrane Review Psychological therapies for the management of chronic pain (excluding headache) in adults Amanda C de C Williams discusses the findings of this review.

Can you tell us about this Cochrane Review and what is new about this update?

This review is the third in Cochrane, and the fourth overall, attempting to answer the question of efficacy of psychological interventions to help people with chronic (persistent) pain. These interventions use a variety of methods targeting behaviour, thoughts, and emotions, to try to enable people with chronic pain to lead more satisfying lives, less limited by pain. These interventions have been used now for about 50 years, and there have been many trials. This review included 75 studies, with 9401 patients completing treatment. This was much larger than our previous Cochrane review in 2012, so we hoped to get a clearer answer as to whether these interventions reduced disability, distress, and pain.

What does the evidence tell us?

We divided the interventions into three groups. The largest was cognitive behavioural therapy (CBT), which aims to help people identify and change unhelpful habits of thinking, and over-pessimistic beliefs about their pain and what it means, alongside ways of encouraging them to increase their range and extent of activities. Then there were two small groups: behaviour therapy (BT), which aims to change people’s habits directly, without cognitive methods, and acceptance and commitment therapy (ACT), which takes a similar behavioural approach to CBT but a different cognitive approach, teaching people to disengage from negative thinking patterns (rather than changing them) and to focus on pursuing valued activities. 

For CBT, where we had 59 studies to combine, there was a negligible positive effect of the intervention on pain levels, and small but robust improvements on disability and distress, all assessed by the individuals’ own reports. Evidence quality was mostly moderate, some low. The improvements in all outcomes were more marked, lasting to follow-up at 6 to 12 months, when treatment was compared with waiting list or treatment as usual than when it was compared with another treatment, such as an exercise programme, educational intervention, or support group. 

We found only 8 studies of BT, with little change in pain, disability, or distress. The quality of evidence was variable and the treatment methods used were quite diverse, so it is hard to draw any helpful conclusions. There were 5 studies of ACT, and all evidence was of very low quality; the results showed a mix of benefits and no effects, but are so uncertain that we have no confidence interpreting them. 

None of the interventions provided even moderate quality evidence on adverse effects, which for psychological interventions are likely to be worsening of symptoms, or dropout because of worsening or disappointment with extent or rate of progress. 

What implications are there for further research?

After our 2012 Cochrane review, we wrote an editorial in the journal PAIN saying that we did not need more studies of CBT, testing minor variations in elements of treatment. However, that is largely what we found in our 2020 update. We now know that there are robust average effects, in that it would take a large number of trials finding no benefit to overturn them, but we know little about the reasons for variation around these averages. We are planning another editorial … 

For BT, although the interventions are in principle distinct from one another, and have a strong basis in acute pain studies, the trials for chronic pain often combine several elements, making effects even harder to interpret. We need to start with well-powered trials that test each technique rather than combining them. Our results for ACT are in marked contrast to the several systematic reviews and meta-analyses that included many small trials (we excluded any with less than 20 people in any trial arm at the end of treatment): these report it to be very effective, albeit mainly for self-reported acceptance of pain rather than for disability or distress. ACT methods have been widely adopted, often replacing CBT, but the evidence we found just does not support this. One of the problems in psychology trials, particularly with newer treatments such as ACT, is that trials are run by enthusiasts for the new treatment. For the next generation of trials, we need more even-handedness. 

What message can policy-makers take from this study?

The diversity of psychological interventions can be bewildering for policy-makers, but some distinctions are important: not all ‘talking therapies’ are the same, or equally effective. Our evidence supports the use of CBT to reduce disability and distress associated with chronic pain, when delivered by trained psychologists, one of the criteria for including trials in our review. Psychology is not ‘common sense’, nor can it be applied without some understanding of psychological processes and without skills to deal with patients’ distress. For the other two types of intervention, BT and ACT, outcomes are uncertain, so effects, both beneficial and adverse, should be monitored and reported.

Friday, August 28, 2020

Cochrane International Mobility - Marina Macchi

Fri, 08/28/2020 - 14:07

Cochrane is made up of 11,000 members and over 67,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Getting involved in Cochrane’s work means becoming part of a global community. The Cochrane International Mobility programme connects successful applicants with a placement in a host Cochrane Group, learning more about the production, use, and knowledge translation of Cochrane reviews. The prgramme offers opportunities for learning and training not only for participants but also for host staff.

In this series, we profile those that have participated in the Cochrane International Mobility Program and learn more about their experiences.

Name: Marina Macchi
Location: Milan, Italy
Cochrane International Mobility location: Cochrane Sweden

How did you first learn about Cochrane?
During my medical school years, I used to read Cochrane reviews, then I started to use some of its online learning tools on research and in particular systematic reviews. One day I saw an online post about the Cochrane International Mobility (CIM) programme and after contacting an Italian student who recently had this experience, I wrote to the Cochrane Sweden supervisor to declare my interest. Unfortunately, a few weeks later COVID19 happened, thus we decided to start the programme virtually.

What was your experience with Cochrane International Mobility?
I had the opportunity to attend webinars and online training courses both on the Cochrane method and on pediatric topics. I also participated in the Cochrane review update on salbutamol for transient tachypnea of the newborn with Matteo Bruschettini and a team of Italian neonatologists. In each step of the review I was supported by an expert reviewer and I definitely learned a lot. I think that this demonstrates how useful technology can be, specially in particular situations!

What are you doing now in relation to your Cochrane International Mobility experience?
We have submitted the Cochrane review update for publication and in the meanwhile I am still attending online webinars. There is always something new to learn!

Do you have any words of advice to anyone conserving a Cochrane International Mobility experience?
I highly recommend you doing this experience. For medical students, it is often difficult to join research projects and find tutors who teach you with passion and dedication, but through the CIM I could  learn and get passionate about research like never before. It is also a unique experience that allows you to work with doctors from other countries and see other points of view.



Wednesday, September 2, 2020

Featured Review: Rapid, point-of-care antigen and molecular-based tests for diagnosis of SARS-CoV-2 infection

Tue, 08/25/2020 - 17:31
How accurate are rapid tests, performed during a health-care visit (point-of-care), for diagnosing COVID-19?

Why is this question important?

People with suspected COVID-19 need to know quickly whether they are infected, so that they can self-isolate, receive treatment, and inform close contacts. Currently, COVID-19 infection is confirmed by sending away samples, taken from the nose and throat, for laboratory testing. The laboratory test, called RT-PCR, requires specialist equipment, may require repeat healthcare visits, and typically takes at least 24 hours to produce a result.

Rapid point-of-care tests can provide a result ‘while you wait’, ideally within two hours of providing a sample. This could help people isolate early and reduce the spread of infection.

What did we want to find out?

We were interested in two types of rapid point-of-care tests, antigen and molecular tests. Antigen tests identify proteins on the virus, often using disposable devices. Molecular tests detect the virus’s genetic material, using small portable or table-top devices. Both test the same nose or throat samples as RT-PCR tests.

We wanted to know whether rapid point-of-care antigen and molecular tests are accurate enough to replace RT-PCR for diagnosing infection, or to select people for further testing if they have a negative result.

What did we do?

We looked for studies that measured the accuracy of rapid point-of-care tests compared with RT-PCR tests to detect current COVID-19 infection. Studies could assess any rapid antigen or molecular point-of-care test, compared with a reference standard test. The reference standard is the best available method for diagnosing the infection; we considered RT-PCR test results and clinically defined COVID-19 as reference tests. People could be tested in hospital or the community. Studies could test people with or without symptoms.

Tests had to use minimal equipment, be performed safely without risking infection from the sample, and have results available within two hours of the sample being collected. Tests could be used in small laboratories or wherever the patient is (in primary care, urgent care facilities, or in hospital).

How did studies assess diagnostic test accuracy?

Studies tested participants with the rapid point-of-care tests. Participants were classified as known to have – and not to have - COVID-19, by RT-PCR in all studies. Studies then identified false positive and false negative errors in the point-of-care test results, compared to RT-PCR. False positive tests incorrectly identified COVID-19 when it was not present, potentially leading to unnecessary self-isolation and further testing. False negatives missed COVID-19 when it was present, risking delayed self-isolation and treatment, and spread of infection.

What we found

We found 18 relevant studies. Ten studies took place in North America, four in Europe, two in South America, one in China and one in multiple countries.

Nine studies deliberately included a high percentage of people with confirmed COVID-19 or included only people with COVID-19. Fourteen studies did not provide any information about the people providing the samples for testing and 12 did not provide any information about where people were tested.

None of the studies reported included samples from people without symptoms.

Main results

Five studies reported eight evaluations of five different antigen tests. Overall, there was considerable variation between the results of the antigen tests in how well they detected COVID-19 infection. Tests gave false positive results in less than 1% of samples.

Thirteen evaluations of four different molecular tests correctly detected an average of 95% of samples with COVID-19 infection. Around 1% of samples gave false positive results.

If 1000 people had molecular tests, and 100 (10%) of them really had COVID-19:

  •  105 people would test positive for COVID-19. Of these, 10 people (10%) would not have COVID-19 (false positive result).
  • 895 people would test negative for COVID-19. Of these, 5 people (1%) would actually have COVID-19 (false negative result).

We noted a large difference in COVID-19 detection between the two most commonly evaluated molecular tests.

How reliable were the results of the studies?

Our confidence in the evidence is limited.

  • Three-quarters of studies did not follow the test manufacturers’ instructions, so may have found different results if they had.
  • Often, studies did not use the most reliable methods or did not report enough information for us to judge their methods. This may have affected estimates of test accuracy, but it is impossible to identify by how much.
  • A quarter of studies were published early online as ‘preprints’ and are included in the review. Preprints do not undergo the normal rigorous checks of published studies, so we are uncertain how reliable they are.

What are the implications of this review?

Studies provided little information about their participants, so it is not possible to tell if the results can be applied to people with no symptoms, mild symptoms, or who were hospitalised with COVID-19. Accurate rapid tests would have the potential to select people for RT-PCR testing or to be used where RT-PCR is not available. However, the evidence currently is not strong enough and more studies are urgently needed to be able to say if these tests are good enough to be used in practice.

How up-to-date is this review?

This review includes evidence published up to 25 May 2020. Because new research is being published in this field, we will update this review soon.

Wednesday, August 26, 2020

Cochrane Sweden has been recognized for its outstanding achievements in promoting evidence-based decision-making in health care by moving from a Cochrane Associate Centre to being awarded full, independent Centre status

Tue, 08/25/2020 - 15:12

Being awarded full, independent Centre status acknowledges Cochrane Sweden’s dedication to producing and disseminating the best available information on health care for clinicians and patients in Sweden and beyond.

Cochrane is a global independent network of researchers, professionals, patients, carers and people interested in health. Cochrane works with collaborators from more than 130 countries to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest, and our evidence is recognized as representing an international gold standard for high-quality, trusted information.

Cochrane Sweden, part of Cochrane since 2017, continues to promote evidence-based decision making in health care in Sweden by supporting and training new authors of Cochrane Reviews, as well as working with clinicians, researchers, professional associations, policy-makers, patients, and the media to encourage the dissemination and use of Cochrane evidence. Cochrane Sweden consists of longstanding, dedicated Cochrane enthusiasts and is located at the Skåne University Hospital, Lund, Sweden.

Being awarded full, independent Centre status acknowledges Cochrane Sweden’s dedication to producing and disseminating the best available information on health care for clinicians and patients in Sweden and beyond. Through their guidance Cochrane Interactive Learning has become a part of the curriculum at the Medical Faculty at Lund University and, more recently, at other Swedish faculties as well. Dina Muscat Meng, Communications Consultant at Cochrane Sweden, helped to launch of the Cochrane International Mobility Programme. Minna Johansson, Director of Cochrane Sustainable Health Care (which is based in Lund) and Karsten Juhl Jørgensen (Cochrane Nordic), toured the country giving talks at conferences and hosting workshops and seminars about Cochrane, which has resulted in an exciting increase in the publication of Cochrane reviews by Swedish authors.

Cochrane Sweden’s Director Matteo Bruschettini says: “We are grateful to Professor Ingemar Petersson, Head of Research at the University Hospital in Lund, for the wise and generous support since the very beginning. We’re also thankful to Professor Jan Kilhamn, Region Västra Götaland, for the support since 2020.

We aim to further expand the successful and strategic collaboration with the Cochrane Centres in Norway and Denmark and to facilitate networking and collaboration among the Scandinavian Cochrane Groups. Together with Martin Ringsten and all staff at Cochrane Sweden, we intend to collaborate in increasing the impact and use of Cochrane Reviews and to continue supporting Cochrane to reach its strategic objectives.”

Cochrane’s CEO Mark Wilson commented:  “I am very pleased with the development of Cochrane Sweden into a full Cochrane Centre. Cochrane Sweden, despite being one of the newer Cochrane Groups, has already contributed substantially to Cochrane’s work in Sweden and beyond. Given the passion and generosity Matteo and team bring to everything they do, I am sure that he and the team will expand the reach and impact of Cochrane evidence in health decision making in Sweden in the coming years.”

Karsten Juhl Jørgensen, Acting Director of Cochrane Nordic, adds: “It has been a great pleasure to see the enthusiasm and growth of Cochrane Sweden over the past few years. We, at Cochrane Nordic, are extremely proud to have contributed our small bit to this development and we look forward to many years of continued collaboration,  expanding our scope and support of Cochrane activities across Scandinavia, also including Cochrane Norway. Gaining full, independent Centre status for Cochrane Sweden is a considerable achievement and very well deserved.”

To mark the Centre status achievement, Cochrane Sweden will be holding an open online virtual seminar, ‘Cochrane – not just randomized trails of treatment effects’ on 1 September. In this webinar they will go over current activities and future initiatives of Cochrane in the Scandinavian countries. Each topic will be presented by experts in the respective field and followed by Q&A and a short discussion.

Tuesday, August 25, 2020

What type of COVID-19 evidence is most useful to you?

Mon, 08/24/2020 - 13:34

Answer this survey to help shape Cochrane’s future COVID-19 response. 

Cochrane’s response to the COVID-19 pandemic so far has been a collaborative effort and drawn on the strengths of our global Community. We are proud of the COVID-19 evidence we have published, and we are grateful for the rapid innovation, flexibility, and responsiveness to changing priorities that our Community has shown. But as an organization that wants our choices to be evidence based – and with the global pandemic likely to continue for the foreseeable future – even at this early stage we want to gather data and a wide range of views on Cochrane’s COVID-19 response, reflect on the findings, and use them to guide our future activities and approaches.

For this reason, over the next month, we would like to hear from you, the users of our evidence.

  • What types of COVID-19 evidence are influencing your decisions? 
  • Where do you get your COVID-19 information from? 
  • What are the types and formats of evidence you need most? 

The answers to the survey will help influence what is produced in the future. We want to hear from everyone about using research evidence – health policy makers, healthcare providers, patients and carers, researchers, and the general public. 

Please provide your input by taking 10-15 minutes to complete this survey by 21st September, 2020:  It’s open to everyone! You do not need to give your name and you can leave any questions blank if they are not relevant to you.

Thank you for helping to shape the future of Cochrane’s COVID-19 response. 

Monday, August 24, 2020

Recruiting for ‘Cochrane UK Consumer Champions’

Mon, 08/24/2020 - 13:04

The Cochrane UK team are inviting applications from people who would like to be ‘Cochrane UK Consumer Champions’.  Deadline: 30 August 2020

The role will largely involve:

  • Raising awareness of Cochrane’s work within the community
  • Advocating for wider use of Cochrane’s work within consumer groups/organizations
  • Promoting consumer involvement within Cochrane and Cochrane Groups
  • Providing a connection between Cochrane and consumers

Cochrane UK invite applications from people who:

  • are based in the UK
  • have experience as a patient, or as a family member/carer for a patient
  • have a keen interest in being, or becoming, a consumer advocate in their own area (whether in their local area or for a particular health condition)

You should be able to commit at least 4 hours a month to the role (maximum of 16 hours per month) and have no conflicts of interest that would prevent participation in the role.

Monday, August 24, 2020

Study shows Cochrane’s centralised search and screening processes are highly sensitive

Thu, 08/20/2020 - 19:23

The Cochrane Central Register of Controlled Trials (CENTRAL) is compiled from a number of sources, including PubMed and Embase. Since 2017, Cochrane and our development partner Metaxis have increased the number of sources feeding into CENTRAL and improved the efficiency of our processes through the use of APIs, machine learning and crowdsourcing , via Cochrane Crowd.

Cochrane’s Centralised Search Service (CSS) is an initiative in Cochrane that aims to populate CENTRAL with reports of randomised and quasi-randomised trials. Currently six different sources  are searched regularly for RCTs.

A recent study published in the Journal of Clinical Epidemiology found that Cochrane's centralised search and screening processes are proving highly sensitive. The CSS is helping to make CENTRAL a comprehensive repository of randomized control trials, supporting review teams globally to find the evidence they need quickly and easily.

Thursday, August 20, 2020

Cochrane seeks Software Test Engineer - Copenhagen, Denmark

Wed, 08/19/2020 - 15:23

Specifications: Permanant, full-time
Salary: £55,000
Location: Copenhagen, Denmark 
Application Closing Date: 4 September 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 test engineer, you'd be leading the testing of our software, as well as helping us upgrade and build automated tests for our product. Our goal is to maintain product development velocity while having confidence in the quality of our code.

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 implementing test strategies for web applications in an Agile setting. Further details are in the job description.

We work in English.

What you'd be doing

  • Working with a talented, passionate and collaborative agile team;
  • Advocating cross-team to ensure quality-minded practices;
  • Designing, implementing, and maintaining automatic and manual test solutions.

How to apply

For further information on the role and how to apply, please click here The deadline to receive your application is by 4th September 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 11th and 14th September 2020.

Wednesday, August 19, 2020 Category: Jobs

Sprains, strains and bruises: Oral non-steroidal anti-inflammatory drugs compared with other oral pain killers

Thu, 08/13/2020 - 11:00

Sprains, strains, and bruises are common injuries, and people with these injuries often require pain relief, given as a tablet or capsule that is swallowed (oral). Many types of oral painkillers are available to treat such injuries. The authors wanted to know whether there were any differences in people’s pain, swelling, function, or unwanted side effects when sprains, strains, and bruises were treated with oral non-steroidal anti-inflammatory drugs (NSAIDs, e.g. ibuprofen) compared with paracetamol, opioids (e.g. codeine), complementary or alternative medicines, or combinations of these.

What did the authors do?
They searched medical databases up to January 2020 for studies that compared NSAIDs with other painkillers in people with sprains, strains, and bruises. Study participants could be any age. They assessed the included studies to judge the reliability (certainty) of the evidence. They categorised the evidence as being of high, moderate, low, or very low certainty. High certainty means they are confident in the evidence, moderate certainty means they are fairly confident, low or very low certainty means that they are unsure or very unsure of the reliability of the evidence.

Results of searches and description of studies
The review includes 20 studies, with 3305 participants. Seven studies included people with ankle sprain only. Three studies included children only. Most of the participants of the other studies were young adults, and there were slightly more men than women. Few participants were aged over 65 years. Eleven studies compared NSAIDs with paracetamol, six studies compared NSAIDs with opioids, and four studies compared NSAIDs with paracetamol combined with an opioid. Studies reported outcomes at times varying from one hour after taking the medication, up to 10 to 14 days.

Main results
There is no difference between NSAIDs and paracetamol in pain after one to two hours, or after two to three days (high-certainty evidence), and there may be no difference after a week or more (low-certainty evidence). There is low-certainty evidence that NSAIDs may make little difference to swelling after a week or more. The authors are uncertain whether NSAIDs make a difference to return to function after a week or more (very low-certainty evidence). There is low-certainly evidence that NSAIDs may slightly increase unwanted side effects related to the gut.

There is probably no difference between NSAIDs and opioids in pain at one hour (moderate-certainly evidence), and there may be no difference four or seven days after taking medication (low-certainty evidence). They are uncertain whether NSAIDs make a difference to swelling after 10 days (very low-certainty evidence). There is low-certainty evidence that NSAIDs may increase return to function in 7 to 10 days. There is moderate-certainty evidence that NSAIDs probably result in fewer unwanted side effects, such as nausea and dizziness, compared with opioids.

The evidence suggests that there is little or no difference between NSAIDs and paracetamol combined with opioids in pain, swelling, return to function, or unwanted side effects. However, the evidence was very low certainty, so the authors are uncertain of these results.

No studies reported the risk of re-injury after treatment. The authors found no studies comparing NSAIDs with complementary or alternative medicines.

The body of evidence to date has found no difference between NSAIDs and other pain killers for pain relief for strains, sprains, and bruises in younger people. However, the authors need more, and better evidence on return to function and unwanted side effects in all age groups, particularly in older people.

Peter Jones Associate Professor of Emergency Medicine at the University of Auckland, Faculty of Medical and Health Sciences and Director of Emergency Medicine Research Adult Emergency Department, Auckland City Hospital summarized:

“Sprains, strains and bruises are common injuries. Often people are unsure which medication to take, anti-inflammatory drugs, paracetamol or an opioid such as codeine or to treat with a complimentary therapy or alternative medicine. We found evidence that there was no difference between the common pain medications in the amount of pain relief achieved. However, we need more, and better evidence on unwanted effects on the gut in all age groups but particularly in older people.”

This is an update of a Cochrane review published in 2015.



Thursday, August 13, 2020

Cochrane joins the Dementia Research Chatathon on 7 September 2020

Wed, 08/12/2020 - 20:20

Dementia Research Chatathon - 7 September, 9:00 (GMT+1)

For 12 hours the host Adam Smith (@BetterResearch) will be chatting with 55 researchers from all fields of dementia research, using video chat – live streamed using Zoom and YouTube. They will discus their research, the latest hot topics in their field, and how they are working to beat the disease and improve the lives of people affected. This event is open to everyone interested in finding out more about the latest research taking place on dementia and information will be accessible to researchers, healthcare professionals, and family and carers. It is a free event with donations being accepted to Alzheimer’s Research UK (@AlzResearchUK).

Dr Terry Quinn (@DrTerryQuinn), Coordinating Editor of Cochrane Dementia and Cogitative Improvement, will be sharing evidence from  Cochrane systematic reviews and meta-analysis in dementia research and will be explaining how the Cochrane group is working to raise standards in research design and reporting.  Dr Quinn will be speaking at the 19:30 - 20:00 GMT timeslot. 

Wednesday, August 12, 2020

Strategy to 2020: Years of transformation

Tue, 08/11/2020 - 21:44

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. 

Watch the video below to see how Strategy to 2020 was developed and change it has ushered in for Cochrane: 

We are now developing a new strategy for the period 2021 to 2025, and we want to hear from you! Let’s collaborate to define Cochrane’s strategy for the next five years. 

Wednesday, August 12, 2020