Research about COVID-19 is growing fast during the pandemic. Healthcare professionals, journalists, policy-makers and people with an interest wanted simple summaries of the latest evidence in Portuguese to help inform their decisions.
To meet this need, Cochrane Portugal produced regular newsletters in the Portuguese language. They included short summaries about new COVID-19 research from around the world and shared the newsletters through their mailing list and on their website.
People are busy so they made sure that every newsletter was not longer than one page and took less than seven minutes to read. They focused on high-quality studies that were relevant in clinical practice and wrote the newsletters in a non-technical way so they could be used by people who were not doctors. Newsletters were sent out twice a week.
Cochrane Portugal received funding from the Institute for Evidence Based Healthcare at the University of Lisbon School of Medicine.
Published on the Cochrane Library is a new editorial, 'COVID‐19: working together and making a difference for decision‐makers'. The editorial outlines Cochrane's agile response to the situation and the many lessons learned.
It also introduces the special supplement to the 'Collaborating in response to COVID‐19: editorial and methods initiatives across Cochrane.' The The supplement collects examples of initiatives for coordinating and preparing for evidence synthesis, facilitating and developing methods for evidence synthesis, organizing collaborative approaches for evidence synthesis and publication, and ensuring evidence informs guidelines and practice.
- Read the Cochrane Library Editorial
- Read the Cochrane Library Supplement
- Read the C0chrane vs. COVID-19 case studies
- Read all the Cochrane resources and news on COVID-19
Thursday, December 10, 2020
Cochrane has expanded its response to COVID-19 by publishing two rapid scoping reviews about care bundles in the intensive care unit (ICU) and measures implemented in schools to contain the SARS-CoV-2 virus. Both reviews were commissioned by the World Health Organisation to inform their guidance. The reviews serve as exemplars for how similar research could be published by Cochrane beyond the pandemic.
Cochrane does not ordinarily publish scoping reviews, which differ from systematic reviews in important ways. Rather than summarise the results of studies to assess the effect of an intervention or accuracy of a diagnostic test, the purpose of a scoping review is to identify the amount and type of evidence relating to a given topic. Scoping reviews can play an important role for researchers and decision makers by mapping and characterizing an evidence base to highlight gaps or inform the design of a further systematic review.
Scoping reviews follow many of the same steps of a systematic review including pre-specification of methods, and a systematic approach to identify, sift and present the evidence. They generally have a broader scope than a systematic review and, given that the objective is not to assess effectiveness or safety, there is usually no critical appraisal of studies, synthesis of their outcome data, or application of established GRADE methods.
The reviews followed a set of interim recommendations set by the Cochrane Editorial and Methods Department (EMD), which were based on existing conduct and reporting standards and guidance.[refs 1,2,3] Areas for development have been highlighted that would be needed to ensure quality and consistency on a wider scale, but the reviews serve as an important proof of concept that we hope to build upon in the future to continue meeting the diverse needs of stakeholders.
Declan Devane, Director of Cochrane Ireland and one of the authors of the ICU care bundles scoping review commented “I think it critical that Cochrane respond to the evidence synthesis needs of health decision makers. Like much of the recent COVID-19 evidence response, this scoping review was only possible in the time available because of the commitment of a team of clinicians and methodologists who were supported flexibly and iteratively by Cochrane. Processes were adapted and flexed to meet commissioners needs resulting in a good experience for all concerned. The learning from our experience will help inform future scoping review processes. I believe firmly that the relevance and value of Cochrane will depend on its ability to respond innovatively, and promptly, to decision-maker needs. This is another example that shows we can.”
A range of initiatives are underway to reflect on what has been achieved by the Cochrane community during the pandemic, including the Cochrane COVID-19 supplement that published this week. The Central Executive Team is considering whether and how new review and article types should be pursued beyond the pandemic situation to meet user needs and accommodate innovation in evidence synthesis. A web-based survey will be circulated in January to invite Cochrane staff and members to share their views.
- PRISMA extension for Scoping Reviews explanatory paper (Tricco, AC, Lillie, E, Zarin, W, O'Brien, KK, Colquhoun, H, Levac, D, Moher, D, Peters, MD, Horsley, T, Weeks, L, Hempel, S et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018,169(7):467-473.)
- JBI Manual for Evidence Synthesis. Chapter 11: Scoping Reviews (Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis, JBI, 2020.)
- Lockwood et al 2019 practical guidance (Lockwood C, Borgess dos Santos K, Pap R. Practical guidance for knowledge synthesis: scoping review methods. Asian Nursing Research. 2019,13(5):287-94.)
Featured Review: What types of interventions benefit people experiencing homelessness to quit smoking?
People experiencing homelessness are more likely to use tobacco, and face many problems that make it difficult for them to quit. Health problems caused by using tobacco are among the leading causes of death among this group of people, so there is a need to find new ways to reduce tobacco use in people experiencing homelessness. Healthcare guidance says that treatment to quit tobacco smoking should include some form of counseling or support, plus medicines designed to help people stop smoking. However, this treatment is often not provided or used among people experiencing homelessness. This review looked at whether systems designed to help adults experiencing homelessness to get treatments to quit tobacco, and treatments designed to help adults experiencing homelessness to quit tobacco lead to more use of treatments and more people quitting tobacco use. The authors also looked at whether treatments to help adults experiencing homelessness to quit tobacco changed their use of other drugs and their mental health
The study included 10 studies involving 1634 participants. One of these studies is still being carried out, but the other nine have been completed. All participants were tobacco smokers, aged 18 years or older, and had experienced homelessness. Most participants were recruited from places within the community, such as homeless shelters, but some were also recruited from healthcare clinics. All studies offered participants some form of counseling support to quit smoking, and eight of these studies also offered stop‐smoking medicines. The treatments tested in the included studies were: e‐cigarettes, text‐message support, rewards for stopping smoking, more intensive counseling support, treatments focused on other lifestyle challenges plus smoking, and cognitive behavioral therapy. The evidence is up to date to January 2020.
There was not enough information to decide whether stop‐smoking treatments targeted specifically at people experiencing homelessness made them more likely to quit smoking than standard treatment to stop smoking. There was also not enough information to determine whether these treatments affected the mental health or drug use of people experiencing homelessness.
Quality of evidence
The authors judged all of the information included in this review to be either of low or of very low quality. This is because the studies included in this review were small, and there were problems with how some of the included studies were carried out. This means it is difficult to know whether these interventions help people who experience homelessness to quit smoking. The findings of this review are very likely to change as new studies are completed.
Featured Review: Antenatal corticosteroids for accelerating fetal lung maturation in women at risk of preterm birth
The Cochrane review about antenatal steroids in reducing risk of infant mortality and morbidity is an important one in Cochrane's history. Cochrane's logo is based on the forest plot from the original publication in 1982. This review has recently been updated and lead author, Fiona Stewart, tells us how the logo might look now, base on the current data.
What does this update tell us?
Our overall findings can be summed up like this: antenatal steroids given to women at risk of preterm birth reduce the risk of infant mortality and morbidity. In other words, babies are more likely to survive and less likely to have serious illness, such as respiratory distress syndrome and intraventricular haemorrhage (bleeding in the brain). The evidence also suggests that there is probably little risk of death or infection in the mothers who receive the steroids.
What is different to the last version?
In the last version of the review, the authors identified a distinct lack of evidence from low- and middle-resource countries. Since then the World Health Organisation has organised two large randomised controlled trials to address precisely this gap and one of those trials is now included in this latest update. This means we now have a much better idea of the benefits and risks of antenatal corticosteroids in a wide range of settings where there are different levels of healthcare service provision.
Another important difference from the last version is that we have taken into account the trustworthiness of the evidence, in addition to the standard methods that we use to assess risk of bias and to rate the overall certainty of evidence. We used a set of criteria, developed by the Cochrane Pregnancy and Childbirth group, to assess whether each trial in the review can demonstrate its trustworthiness in terms of research governance and feasibility of results. Where we had concerns about a trial’s trustworthiness we contacted the study authors for further information. Where our concerns were not resolved or where we did not receive any response, we did not include those trials in our analysis.
The Cochrane logo is based on the forest plot of the first publication of this review. Each horizontal line represents the results of one study, while the diamond represents the combined result - our best estimate of whether the treatment is effective or harmful. The diamond sits clearly to the left of the vertical line representing “no difference”; therefore the evidence indicates that the treatment is beneficial. Would this update to the review change the forest plot that the logo is based on?
The Cochrane logo represents what the forest plot would have looked like in 1982, had a meta-analysis been carried out using the trial evidence that was available at the time for the outcome of neonatal mortality. Now, decades later, we have substantially more evidence and if the logo was created from scratch now we wouldn’t be able to fit enough horizontal lines in it to illustrate the number of trials we now have included in the analysis! Most importantly, the diamond at the bottom would still be in the same place because the analysis in the logo and the analysis in our update both show that antenatal steroids reduce the risk of neonatal death compared to placebo or no treatment.
What can clinicians/and or mothers take from this evidence?
Clinicians and mothers can be confident that there is high-certainty evidence to support the use of antenatal steroids for women at risk of preterm birth, no matter where you are in the world since the evidence is consistent across high-, middle- and lower-resource settings. The evidence also demonstrated that giving antenatal steroids to mum is safe and does not result in any long-term harm to their babies. However it is important that they are only given to women considered at high risk of preterm birth because appropriate timing is very important to ensure maximum benefit.
Will this review be updated again?
Yes, the review will be updated to include the results of trials that are still ongoing. There are still a few remaining questions; firstly, whether antenatal steroids have the same benefits in different gestational age ranges. The majority of the evidence in the review comes from trials where the women were very preterm (approximately 28-34 weeks). We would like to know if the effect of corticosteroids compared with placebo is similar at the later preterm period (approximately 34-36 weeks). We know of at least one large trial – ACTION-II, organised by the WHO – which is investigating antenatal corticosteroids compared with placebo in women at 34-36 weeks. We anticipate being able to include the results from that trial, and four smaller trials that are ongoing, in another update in a year or so. Secondly, we are interested in the effects of antenatal steroids in particular groups for whom there is currently limited evidence; for instance, women with medical problems in pregnancy such as diabetes, or women who are carrying more than one child.
Wearing Cochrane evidence: a personal story of impact
Rebecca Selby, a mum of four, shares how this Cochrane Review has impacted her family.
- Read the updated review
- Learn more about Cochrane Pregnancy and Childbirth
- Read a personal impact story: “Wearing Cochrane evidence”
- Watch “What is a Systematic Review?”
- Read about the history and meaning of the Cochrane logo
New Cochrane Systematic Review shows that knee replacement surgery using a tourniquet increases the risk of serious complications, and causes additional pain after surgery
What are the benefits and risks of using a tourniquet in knee replacement surgery?
Senior author Mr Peter Wall, Consultant Orthopaedic Surgeon from Warwick Clinical Trials Unit and University Hospitals Coventry and Warwickshire NHS Trust, summarized:
The evidence indicates that knee replacement surgery performed with a tourniquet increases the risk of serious complications needing additional healthcare, many of which might be avoided if a tourniquet is not used. Most people do very well after knee replacement, but like any major surgery, there are risks and use of a tourniquet may exacerbate these.
Why is this question important?
Knee replacement is a common operation that involves replacing a damaged, worn, or diseased knee with an artificial joint made of metal and plastic. Most surgeons prefer to carry out knee replacement surgery with the aid of a tourniquet ‐ a tight band placed around the thigh that restricts blood flow to the knee. Potential benefits of using a tourniquet include limiting blood loss during surgery and making it easier to conduct the operation. However, a tourniquet may increase the risk of pain and complications for patients after surgery.
How did the authors identify and evaluate the evidence?
First, they searched for relevant, robust studies in the medical literature. They then compared the results and summarised the evidence from all studies. Finally, they assessed how certain the evidence was. To do this, they considered factors such as the way studies were conducted, study size, and consistency of findings across studies. Based on these assessments, they categorised the evidence as being of very low, low, moderate, or high certainty.
What did they find?
They found 41 studies that involved 2819 people (944 men and 1777 women) who were randomly assigned to have surgery with a tourniquet, or surgery without. This type of study, known as a randomised controlled trial, provides the most robust evidence about the effects of a treatment.
Studies were conducted in hospitals in Australia, Asia, Europe, and the USA. Each study involved between 20 and 166 people who were between 58 and 84 years of age. They were followed for between one day and two years after surgery.
Five studies were publicly funded, and one study received funding from a medical equipment manufacturing company. The other 35 studies did not receive specific funding or did not state who funded them.
The studies provided low to moderate evidence that:
- Pain on the first day after surgery is probably worse with a tourniquet. On average, on a scale of 0 to 10 (higher scores = worse pain), people operated on with a tourniquet rated their pain as 5.81. People operated on without a tourniquet rated their pain as 4.56 (average difference: 1.25 points);
- Knee function one year after surgery is probably similar with or without a tourniquet. On average, on a scale of 0 to 100 (higher scores = better functioning), people operated on with a tourniquet rated their knee function as 89.74. People operated on without a tourniquet rated their knee function as 90.03 (average difference: 0.29 points);
- Satisfaction with treatment may be similar with or without a tourniquet. Six months after the operation, 94% of people operated on with or without a tourniquet were 'extremely' or 'very' satisfied with their treatment;
- There may be little or no difference in health‐related quality of life with or without a tourniquet. On average, on a scale of 0 to 100 (higher scores = better quality of life), people operated on with a tourniquet rated their quality of life as 54.64. People who had surgery without a tourniquet rated their quality of life as 56.17 (average difference: 1.53 points); and
- Serious adverse events such as blood clots in the leg or lung, infection, or re‐operation other than to replace the artificial joint are probably more likely to occur with a tourniquet. Five per cent of people operated on with a tourniquet reported serious adverse events compared to 2.9% of people operated on without a tourniquet.
We do not know if using a tourniquet affects chances of needing a second operation to replace an artificial joint because available evidence is of very low certainty.
No studies investigated the effects of surgery with a tourniquet on people’s ability to process thoughts (cognitive function).
What does this mean?
Knee replacement with a tourniquet is probably slightly less beneficial, and is associated with greater risks, than surgery without a tourniquet.
How up‐to‐date is this review?
Evidence in this Cochrane Review is current to March 2020.
Featured Review: Helping families secure a step‐up to emergency care for patients with a life-threatening condition
A life‐threatening condition is a medical emergency. The faster a person secures the right medical care, the better their chances of surviving. When patients and their families know the signs of a life‐threatening medical emergency and how best to communicate concerns around a deterioration in health, they can act quickly to seek emergency care and work with staff to ensure a timely response.
Increasing patient and family involvement
Education and coaching are available to help patients and their families, and healthcare professionals work together to make sure patients and families can secure emergency care when needed. These strategies focus on:
- helping patients and their families to notice changes in a patient's condition and tell healthcare staff about them;
- empowering patients and families to feel confident about arranging for urgent or emergency care;
- healthcare staff giving patients and families a chance to talk about their concerns, and actively listening to them during an emergency consultation; and
- training healthcare staff to respond appropriately when patients and their families raise concerns about a patient's condition.
Why we did this Cochrane Review
We wanted to find out if education and coaching strategies could help patients and families to recognise when changes in a health condition are life‑threatening and act to help secure emergency care.
What did we do?
We searched for studies that tested strategies to involve and empower patients and their families in seeking emergency care for a life‐threatening medical condition. We also included studies where the strategy included a component targeted at enabling staff response.
We looked for studies in which the strategies people received were decided at random. This type of study usually gives the most reliable evidence about the effects of a strategy.
Search date: we included evidence published up to 21 October 2019.
What we found
We found nine relevant studies in different healthcare settings in which 436,684 patients and family members took part. Seven of the strategies studied involved face‐to‐face education or coaching sessions for patients and families, and two involved education programmes aimed at healthcare staff as well as patients and their families. All strategies had an educational part and an engagement part (for example, self‐monitoring; using action plans); two strategies additionally focused on communication skills and using shared language.
All studies compared usual care against receiving strategies to increase involvement of patients and their families in seeking emergency care. In four studies, people in the usual care group also received information or educational strategies. The studies varied in design and in their assessments, making it difficult to compare all their results.
We did not find any studies that looked at patients', or their families', satisfaction with care, or what they thought of their involvement in seeking emergency care.
What are the results of our review?
Compared with usual care, strategies to improve involvement in securing emergency care:
- may help patients and their families to know which danger signs to look for, and to know the right action to take (4 studies; 3086 people);
- probably have little to no effect on stillbirth in pregnancy (1 study; 409,175 people); and
- probably do not increase anxiety levels in patients and their families (1 study; 2,597 people).
We are uncertain if the strategies affected:
- peoples' confidence in recognising and reporting worsening in a health condition (2 studies; 217 people); or
- the time between the start of life‐threatening symptoms and receiving emergency treatment (4 studies; 27,023 people).
Our confidence in our results
We are moderately confident about the effect of the strategies on anxiety levels and on stillbirth, although these results might change with further evidence. We are less confident about our other findings, which are likely to change with further evidence. Some of the studies we compared had small numbers of people taking part, so their results may have been unreliable.
Strategies to help patients and their families to secure emergency care may improve their knowledge about life‐threatening conditions, and probably don't increase their anxiety more than usual care
Early in the COVID-19 pandemic, primary care doctors (general practitioners) and nurses had many questions. Cochrane Belgium wanted to create clear answers to primary care clinicians’ most frequent questions about COVID-19, based on scientific evidence, making the answers relevant to Belgium.
A university collected questions that were relevant to primary care in Belgium. Masters students studying medicine worked in pairs to draft answers in the Dutch language. Cochrane Belgium checked and validated each of these rapid answers to make sure they were accurate, consistent and evidence-based. They also developed criteria to assess each of the answers.
Author interview: the role of cognitive behavioural therapy for anxiety disorders in children and adolescents
In this short interview, Postdoctoral Researcher and lead author Tessa Reardon tells us about this recently published review.
What does this Cochrane review tell us about the role of cognitive behavioural therapy for anxiety disorders in children and adolescents?
Our review shows the key role cognitive behaviour therapy (CBT) plays in the treatment of anxiety disorders in children and adolescents. CBT is the most frequently evaluated treatment for these disorders. Indeed, this review includes 88 studies which is more than twice as many studies as the previous Cochrane review on this topic. Encouragingly, our findings reinforce previous conclusions that CBT is more effective than no treatment for anxiety disorders in children and adolescents. We didn’t find evidence that CBT is superior to alternative treatments, but few studies have compared CBT to alternative treatments so we are still not sure about this. The review also tells us most about the short-term benefits of CBT, and we still know relatively little about the extent to which these benefits continue in the medium to longer term.
What can CBT practitioners take from this evidence?
CBT practitioners can be reassured by the evidence of an advantage of CBT compared to waiting lists and no treatment. CBT can be provided in a range of different ways, for example, practitioners can work one-to-one with children, deliver group sessions, work with parents, deliver brief or longer treatments. Importantly, we did not find clear evidence that one way of providing CBT is more effective than another. A particular challenge facing practitioners and services is the very limited access to CBT for children and adolescents with anxiety disorders, and our findings suggest that practitioners can deliver relatively brief CBT interventions, without a negative impact on short-term outcomes.
Nevertheless, CBT practitioners cannot be complacent. This review suggests that about half of children and adolescents will recover from their primary anxiety disorder following a CBT intervention and this means that the other half do not recover. As researchers, we now need to focus on identifying how we can improve these recovery rates and what these children and young people who do not benefit from current CBT interventions need.
What can parents/carers of children and adolescents with anxiety disorders learn from this review?
Parents and carers can also be reassured that lots of studies have now evaluated CBT, and this review shows that CBT works well for many children and young people with anxiety disorders. However, it is equally important that parents and carers are aware that not all children and adolescents benefit from CBT, and some may need alternative support.
The extent to which parents are involved in CBT programmes for children and adolescents varies considerably – from little to no involvement, through to parent-led approaches where therapists support parents to apply CBT skills and strategies in their child’s daily life. We did not find evidence that one way of providing CBT is consistently better than another, but, not surprisingly, the parent-led approach has typically been tested with primary and preschool aged children, rather than teenagers.
The global pandemic has bought about concerns about increasing anxiety among children and adolescents - what can this review tell us about the role of CBT as treatment during this time?
Before the pandemic, anxiety disorders were common among children and adolescents, with concerns about increasing prevalence rates, particularly among adolescents. The pandemic has increased these concerns even further. Before the pandemic, we also knew that only a small minority of children and adolescents with anxiety disorders were accessing CBT, and the pandemic will have meant that even fewer children who may benefit from CBT are receiving it. Maximising the efficiency of CBT delivery is more important than ever to help ensure that children and adolescents can access effective treatment when they need it. Reducing the amount of therapist contact time involved in treatment and online delivery are both ways to potentially improve treatment efficiency. Encouragingly, this review indicates that CBT involving less than 10 hours of clinical contact can achieve similar outcomes to much longer treatments. Online delivery was beyond the scope of this review, but there is growing evidence that online CBT is also effective for children and adolescents with anxiety disorders.
It is with the deepest disappointment that we must confirm that as a result of the continued global spread and impact of COVID-19 (Coronavirus), we have taken the decision to cancel the Global Evidence Summit (GES 2), due to be hosted in Prague between 5-8 October 2021.
The Global Organizing Committee (comprising four partners: Cochrane, JBI, GIN and Campbell) concluded, with the agreement of our local host - CEBHC-KT and Masaryk University, that the most appropriate decision is to cancel the Summit in Prague in its entirety for 2021 and postpone it until 2 – 6 October 2023.
As global leaders in evidence-informed healthcare, the partners take very seriously our responsibility and duty of care to our communities in the face of continuing risks associated with the spread of the coronavirus for the foreseeable future.
However, we are committed to working together, along with additional organizations to present the second annual World EBHC Day on the 20 October, 2021. This is a global initiative that raises awareness of the need for better evidence to inform healthcare policy, practice and decision making in order to improve health outcomes globally. The inaugural World EBHC Day that took place on 20 October 2020 was a great success. The intention for 2021 is to build on this year’s work and continue to celebrate the impact of individuals and organizations worldwide, recognizing the work of dedicated researchers, policymakers and health professionals in improving health outcomes.
Thursday, November 26, 2020
The cancellation of the second Global Evidence Summit is extremely disappointing news for all of us and we would like to thank the huge amount of people, including our local hosts, who have been working so hard on the preparations. We are in no doubt that we will be able to build successfully on the work accomplished so far to ensure that when GES 2 does go ahead in October 2023 in Prague it will be everything we anticipated: a world-class scientific event and a memorable gathering of the evidence-based medicine community in the historical capital of Bohemia.
We thank you for your ongoing support and commitment to the Global Evidence Summit and will look forward to meeting again for this unique event in 2023.
We hope that you all remain safe and well during these extraordinary times.
With our very best wishes,
Director, CEBHC-KT (Czech Cochrane, JBI and GRADE centres), Chair of the GES Scientific Committee and Local Organizing Committee
Executive Director, Joanna Briggs Institute
CEO, Guidelines International Network
CEO, The Campbell Collaboration
Cochrane Library Editor in Chief to present at Brigham and Women's Hospital Surgical Grand Rounds on 2 December
Dr. Karla Soares-Weiser, Editor in Chief of the Cochrane Library, will present at Brigham and Women's Hospital Surgical Grand Rounds on December 2, 2020, as part of the Professional Fulfillment Virtual Series. In the presentation, titled "Leadership, systematic reviews, and COVID: An international perspective", Dr. Soares-Weiser will reflect on her professional trajectory, Cochrane and its mission, and how Cochrane has confronted the COVID-19 pandemic.
All are welcome to join this presentation on December 2, 2020 from 8:15-9:15 am EST (check the time in your time zone). Please click the following link to access the Grand Rounds webinar: https://partners.zoom.us/j/81328907313Thursday, November 26, 2020
On 26th November 2020, the World Health Organization (WHO) launched their guidelines on physical activity and sedentary behaviour. This Special Collection curated by the Cochrane Campbell Global Ageing Partnership includes associated relevant topics addressing healthy ageing, aligning with the concerted global action of the Decade of Healthy Ageing (2020 to 2030). The WHO defines healthy ageing as “the process of developing and maintaining the functional ability that enables wellbeing in older age”. Functional ability includes people meeting their basic needs, being mobile, continuously learning and growing, building and maintaining relationships, and participating in society.
Older age can be accompanied by a greater risk of developing chronic non-communicable diseases, and associated functional limitations. People aged 60 years old and over account for nearly 25% of the disease burden arising from these conditions. However, being free of disease or health conditions is not a requirement for healthy ageing and many older adults have health conditions that can be well managed and therefore have little impact on their quality of life.
Physical activity plays a critical role in promoting healthy ageing, and evidence from epidemiological studies has determined that it is strongly associated with healthier ageing. Regular and adequate levels of physical activity have multiple health and wellbeing benefits and can prevent, or even reverse, some effects of chronic conditions across a lifespan. Popular ways to be active are through walking, cycling, dancing, and engaging in hobbies. Any other physical activity that is performed during leisure time, or during work, can have also have health benefits.
This years’ United Nations International Day of Older Persons focused on how the COVID-19 pandemic affects how ageing is addressed. The impact of quarantine, often in isolation, at home will have a substantial deconditioning effect, affecting millions of older people. Physical inactivity has been shown to be associated with noncommunicable diseases and higher mortality, and activity is now more important than ever, given COVID-19 restrictions.
This Special Collection brings together a selection of Cochrane Reviews assessing the benefits of physical activity interventions on activity levels, physical function, and symptoms. The reviews synthesize evidence regarding the general population, or groups of people who have specific health conditions. A future Special Collection will focus on specific exercise interventions.
China was the first country to identify COVID-19, but people didn’t know much about the virus in the early stages of the pandemic. To address this need for information, Cochrane China used the mobile telephone social media app WeChat to find out what doctors, nurses and members of the public wanted to know about COVID-19 and to share evidence with them.
Specifically, Cochrane China used WeChat to: advertise a survey to find out what doctors and nurses wanted to know about preventing and treating COVID-19, to invite volunteers to help them find evidence and translate it, and to keep in touch with people who were interested in their ongoing work.
- Learn more about what Cochrane China achieved by harnessing the power of social media during a pandemic, and what they learned in the process in this short case study.
Cochrane First Aid vs COVID-19: Making sure COVID-19 evidence is available in people’s preferred language
Cochrane published a rapid review about whether cleaning hands with ash reduces the spread of COVID-19 and other infectious diseases in areas where soap is not widely available. It was important to get this evidence out widely, so Cochrane First Aid translated the rapid review findings into six languages.
Cochrane First Aid worked with volunteers, and partnered with a number of organizations, to help to share evidence about handwashing with ash with lay people who educate the public in low-income countries. They also created a Blogshot (short visual summary) and used social media and their newsletter to share this review with a wide audience.
- Learn more about how Cochrane First Aid made sure this evidence was available to people in their preferred language in this short case study.
Stroke is a leading cause of death and disability worldwide. The chances of having a stroke increase with age and older people also appear to suffer greater consequences from COVID-19. There may be a link between COVID-19 and new strokes, so healthcare professionals may be caring for people who have both COVID-19 and stroke.
Cochrane Stroke heard from stroke care professionals and researchers that it was difficult to find relevant material amongst the thousands of articles available. To address this need, they collated useful resources for stroke care teams on their website. In addition, they made it easier for people to find relevant publications themselves by creating search strategies for stroke and Covid-19 for major databases including Google, MEDLINE, Pubmed, ClinicalTrials.gov, and The Cochrane Library.
- Learn more about how Cochrane Stroke approached this challenge, and what they learned in the process in this short case story.
Cochrane provides high-quality, relevant and up-to-date synthesized research evidence to inform health decisions. This page highlights the many ways that Cochrane has successfully responded to COVID-19 around the world. Click on any of the case studies below to find out more, and check back often as we continuously add and update new stories.
Making COVID-19 evidence easier to find - Cochrane Stroke heard from stroke care professionals and researchers that it was difficult to find relevant material amongst the thousands of articles available. Learn how Cochrane Stroke addressed this challenge.
Making sure COVID-19 evidence is available in people’s preferred language - Cochrane published a rapid review about whether cleaning hands with ash reduces the spread of COVID-19 and other infectious diseases in areas where soap is not widely available. Read how Cochrane First Aid made sure this evidence was available to people in their preferred language.
Shaping and sharing COVID-19 evidence with social media - Cochrane China used the mobile telephone social media app WeChat to find out what doctors, nurses and members of the public wanted to know about COVID-19 and to share evidence with them. Learn more about what Cochrane China achieved by harnessing the power of social media during a pandemic, and what they learned in the process.
Tuesday, November 24, 2020 Category: The difference we make
What are routine laboratory tests?
Routine laboratory tests are blood tests that assess the health status of a patient. Tests include counts of different types of white blood cells (these help the body fight infection), and detection of markers (proteins) that indicate organ damage, and general inflammation. These tests are widely available and in some places they may be the only tests available for diagnosis of COVID-19.
What did the authors want to find out?
People with suspected COVID-19 need to know quickly whether they are infected so that they can self-isolate, receive treatment, and inform close contacts.
Currently, the standard test for COVID-19 is usually the RT-PCR test. In the RT-PCR, samples from the nose and throat are sent away for testing, usually to a large, central laboratory with specialist equipment. Other tests include imaging tests, like X-rays, which also require specialist equipment.
The authors of this review wanted to know whether routine laboratory tests were sufficiently accurate to diagnose COVID-19 in people with suspected COVID-19. They also wanted to know whether they were accurate enough to prioritize patients for different levels of treatment.
What did the author team do?
Authors searched for studies that assessed the accuracy of routine laboratory tests to diagnose COVID-19 compared with RT-PCR or other tests. Studies could be of any design and be set anywhere in the world. Studies could include participants of any age or sex, with suspected COVID-19, or use samples from people known to have – or not to have - COVID-19.
What authors found
The authors found 21 studies that looked at 67 different routine laboratory tests for COVID-19. Most of the studies looked at how accurately these tests diagnosed infection with the virus causing COVID-19. Four studies included both children and adults, 16 included only adults and one study only children. Seventeen studies were done in China, and one each in Iran, Italy, Taiwan and the USA. All studies took place in hospitals, except one that used samples from a database. Most studies used RT-PCR to confirm COVID-19 diagnosis.
Accuracy of tests is most often reported using ‘sensitivity’ and ‘specificity’. Sensitivity is the proportion of people with COVID-19 correctly detected by the test; specificity is the proportion of people without COVID-19 who are correctly identified by the test. The nearer sensitivity and specificity are to 100%, the better the test. A test to prioritize people for treatment would require a high sensitivity of more than 80%.
Where four or more studies evaluated a particular test, the authors of this review pooled their results and analyzed them together. Their analyses showed that only three of the tests had both sensitivity and specificity over 50%. Two of these were markers for general inflammation (increases in interleukin-6 and C-reactive protein). The third was for lymphocyte count decrease. Lymphocytes are a type of white blood cell where a low count might indicate infection.
How reliable are the results?
Confidence in the evidence from this review is low because the studies were different from each other, which made them difficult to compare. For example, some included very sick people, while some included people with hardly any COVID-19 symptoms. Also, the diagnosis of COVID-19 was confirmed in different ways: RT-PCR was sometimes used in combination with other tests.
How up-to-date is this review?
The authors searched all COVID-19 studies up to 4 May 2020.
Who do the results of this review apply to?
Routine laboratory tests can be issued by most healthcare facilities. However, these results are probably not representative of most clinical situations in which these tests are being used. Most studies included very sick people with high rates of COVID-19 virus infection of between 27% and 76%. In most primary healthcare facilities, this percentage will be lower.
What does this mean?
Routine laboratory tests cannot distinguish between COVID-19 and other diseases as the cause of infection, inflammation or tissue damage. None of the tests performed well enough to be a standalone diagnostic test for COVID-19 nor to prioritize patients for treatment. They will mainly be used to provide an overall picture about the health status of the patient. The final COVID-19 diagnosis has to be made based on other tests.
Implications for practice
None of these markers as stand‐alone tests are useful for accurately ruling in or ruling out COVID‐19. As a triage test would require a high sensitivity (< 80%), these tests have limited value as triage tests. Although there is low or very low certainty about the summary estimates in this review, we do not expect that studies with a low risk of bias will show a better performance than the tests included.
Implications for research
Future studies focusing on the usefulness of routine laboratory tests for COVID‐19 may consider a more representative sample of the population, focus on markers with prespecified, clinically sound cut‐offs and focus on single, but also on the combination of regular blood markers. Furthermore, considering the test results as continuous values may be more informative, as larger deviations from the reference values will have greater impact on the health status of the tested people, and might enable more personalized treatment.
In 2016, Cochrane Pregnancy and Childbirth published a systematic review looking at if skin-to-skin contact improved breastfeeding rates and helped babies adjust to the outside world. They looked at the results of 46 studies which included almost 4000 mothers and their babies. Overall, their review supports the use of skin-to-skin to encourage breastfeeding. The evidence suggests that early skin-to-skin should be normal practice for healthy newborns including those born by caesarean and babies born early at 35 weeks or more. Even where skin-to-skin is possible only for a short time, it will still encourage successful breastfeeding one to four months post birth. Importantly, the findings of improved breastfeeding rates were found in diverse countries and among women of low and high socio-economic class.
Since publication, this review has informed 20 sets of guidelines around the world, with the World Health Organisation (WHO) referencing the review in their 2017 guidance for promoting and supporting breastfeeding. It has been translated into five languages.
Elizabeth Moore, Associate Professor of Nursing at Vanderbilt University School of Nursing and lead author of the review said:
"I have really been amazed at the impact that this Cochrane Review has had around the world. It started as just a gut feeling I had as a breastfeeding consultant over 20 years ago that placing mothers and babies together skin-to-skin right after birth would help them breastfeed more successfully. Since then, this profound, but simple intervention has spread throughout the world based on the evidence in this review.”
In the UK, NICE has used the evidence in their 2006 guidance, and the latest revision in 2015, with the recommendation that women have skin-to-skin contact with their babies after birth. The Royal College of Nursing, UNICEF and Public Health England have all cited the research to promote skin-to-skin contact after birth. As a result, a 2019 survey by the Care Quality Commission reported that 93% of women in England had skin-skin contact after birth.
In June 2020, the WHO stated that skin-to-skin contact and breastfeeding should still be encouraged for new mothers and their babies in cases of suspected or confirmed COVID-19. Early evidence suggests that the benefits of skin-to-skin and breastfeeding far outweigh any risks.
- Read the full Cochrane Review: Early skin‐to‐skin contact for mothers and their healthy newborn infants
- Read the Plain Language summary in English, Deutsch, Español, Français, Hrvatski, 日本語, 한국어, Bahasa Malaysia, Português, Русский, ภาษาไทย, and 繁體中文
- Visit the Cochrane Pregnancy and Childbirth Website
- Listen to the lead author explain the results
- Read 'Case study: Skin-to-skin contact to encourage breastfeeding' on NIHR
Why is this question important?
Basal cell carcinoma (BCC) is the most common form of skin cancer among people with white skin.
BCC is not usually life‐threatening but if left untreated, it can cause important disfigurement, especially on the face.
Surgical removal of the affected area and surrounding skin is usually the first option for treating BCC. Several different surgical approaches exist as well as non‐surgical treatments, such as radiotherapy (high doses of radiation that kill cancer cells), and anti‐cancer creams, gels and ointments.
We reviewed the evidence from research studies, to find out which treatments work best for BCC.
How did we identify and evaluate the evidence?
We searched for randomised controlled studies (studies where people are randomly put into one of two or more treatment groups), because these provide the most robust evidence about the effects of a treatment. We compared and summarised the evidence from all the studies. Finally, we rated our confidence in the evidence, based on factors such as study methods and sizes, and the consistency of findings across studies.
What did we find?
We found 52 studies that involved a total of 6690 adults with BCC. Most studies (48 out of 52) included hospital outpatients with small, superficial or nodular BCC. Studies lasted for between six weeks and 10 years (average duration: 13 months). Twenty‐two studies were funded by pharmaceutical companies.
Our confidence in the evidence presented here is low to moderate, mainly because many studies were small.
Comparison between different surgical treatments
- Mohs micrographic surgery (a specialised surgical approach that removes less skin) may slightly decrease recurrence rates at three and five years compared to surgical excision (one of the most common surgical treatments for BCC).
- There may be little to no difference in how well scars heal between these two surgical treatments according to patients and observers (one study).
Surgery versus non‐surgical treatments
Compared against surgical excision:
- Imiquimod (an anti‐cancer cream) probably increases BCC recurrence rates at three and five years. There may be little to no difference in scar healing according to patients, although imiquimod may increase chances of scars healing well when healing is rated by an observer (one study).
- Radiotherapy may increase BCC recurrence rates at three and four years, and probably decreases chances of scars healing well (one study).
- MAL‐PDT, a type of photodynamic therapy (that uses a light source and light‐sensitive medicine to kill cancer cells), may increase BCC recurrence rates at three years. MAL‐PDT probably increases chances of scars healing well (two studies).
Comparison of different non‐surgical treatments
Compared against imiquimod:
- MAL‐PDT probably increases BCC recurrence rates at three and five years. There is probably little to no difference in scar healing (one study);
What does this mean?
Overall, the evidence suggests that:
- surgery could reduce chances of BCC recurrence;
- non‐surgical treatments such as anti‐cancer creams or photodynamic therapy carry an increased chance of BCC recurrence, but could increase chances of scars healing well compared with surgery.
Complications with surgical treatments include wound infections, skin graft failure and bleeding after the procedure. Non‐surgical treatments frequently lead to localised itching, weeping, pain and redness. Treatment‐related side effects that caused modifications to the study or the withdrawal of participants occurred with imiquimod and MAL‐PDT.
How‐up‐to date is this review?
The evidence in this Cochrane Review is current to November 2019
An updated Cochrane review published today in the Cochrane Library summarizes randomized trial evidence about face masks, hand washing and physical distancing to interrupt or reduce the spread of respiratory viruses. The review will inform revised guidance due to be released by the World Health Organisation.
Lisa Bero, Cochrane Public Health and Health Systems Senior Editor and an author on an Editorial published to accompany this review said, “The results of this review should be interpreted cautiously, and the uncertain findings should not be taken as evidence that these measures are not effective. Most of the trials looked at the effects of measures like face masks and hand washing on their own, however no single measure alone will be enough to reduce the spread of COVID-19. Public health decision makers need to consider all of the available evidence and are likely to act on uncertain evidence if the intervention has the potential to protect the health of large populations and it is unlikely to lead to very serious harm.”
What are respiratory viruses?
Respiratory viruses are viruses that infect the cells in your airways: nose, throat, and lungs. These infections can cause serious problems and affect normal breathing. They can cause flu (influenza), severe acute respiratory syndrome (SARS), and COVID-19.
How do respiratory viruses spread?
People infected with a respiratory virus spread virus particles into the air when they cough or sneeze. Other people become infected if they come into contact with these virus particles in the air or on surfaces on which they have landed. Respiratory viruses can spread quickly through a community, through populations and countries (causing epidemics), and around the world (causing pandemics).
How can we stop the spread of respiratory viruses?
Physical measures to try to stop respiratory viruses spreading between people include:
- washing hands often;
- not touching your eyes, nose, or mouth;
- sneezing or coughing into your elbow;
- wiping surfaces with disinfectant;
- wearing masks, eye protection, gloves, and protective gowns;
- avoiding contact with other people (isolation or quarantine);
- keeping a certain distance away from other people (distancing); and
- examining people entering a country for signs of infection (screening).
Why the authors did this Cochrane Review
The authors of this review wanted to find out whether physical measures stop or slow the spread of respiratory viruses.
What did authors do?
The authors searched for studies that looked at physical measures to stop people catching a respiratory virus infection.
They were interested in how many people in the studies caught a respiratory virus infection, and whether the physical measures had any unwanted effects.
Search date: This is an update of a review first published in 2007. We included evidence published up to 1 April 2020.
What the authors found
Review authors identified 67 relevant studies. They took place in low-, middle-, and high-income countries worldwide: in hospitals, schools, homes, offices, childcare centres, and communities during non-epidemic influenza periods, the global H1N1 influenza pandemic in 2009, and epidemic influenza seasons up to 2016. No studies were conducted during the COVID-19 pandemic. The authors identified six ongoing, unpublished studies; three of them evaluate masks in COVID-19.
One study looked at quarantine, and none eye protection, gowns and gloves, or screening people when they entered a country.
The authors assessed the effects of:
- medical or surgical masks;
- N95/P2 respirators (close-fitting masks that filter the air breathed in, more commonly used by healthcare workers than the general public); and
- hand hygiene (hand-washing and using hand sanitiser).
What are the results of the review?
Medical or surgical masks
Seven studies took place in the community, and two studies in healthcare workers. Compared with wearing no mask, wearing a mask may make little to no difference in how many people caught a flu-like illness (9 studies; 3507 people); and probably makes no difference in how many people have flu confirmed by a laboratory test (6 studies; 3005 people). Unwanted effects were rarely reported, but included discomfort.
Four studies were in healthcare workers, and one small study was in the community. Compared with wearing medical or surgical masks, wearing N95/P2 respirators probably makes little to no difference in how many people have confirmed flu (5 studies; 8407 people); and may make little to no difference in how many people catch a flu-like illness (5 studies; 8407 people) or respiratory illness (3 studies; 7799 people). Unwanted effects were not well reported; discomfort was mentioned.
Following a hand hygiene programme may reduce the number of people who catch a respiratory or flu-like illness, or have confirmed flu, compared with people not following such a programme (16 studies; 61,372 people). Few studies measured unwanted effects; skin irritation in people using hand sanitiser was mentioned.
How reliable are these results?
The authors' confidence in these results is generally low for the subjective outcomes related to respiratory illness, but moderate for the more precisely defined laboratory-confirmed respiratory virus infection, related to masks and N95/P2 respirators. The results might change when further evidence becomes available. Relatively low numbers of people followed the guidance about wearing masks or about hand hygiene, which may have affected the results of the studies.
We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses.
Hand hygiene programmes may help to slow the spread of respiratory viruses.