New independent study finds Cochrane’s transparency over reporting financial conflicts of interest is leading the way
A study published in BMJ Open this month, concludes “the percentage of recent Cochrane meta-analyses on the effects of drug interventions that transparently reported funding sources and trial author–industry financial ties and employment for included trials far exceeds reporting in other journals.” Transparency of funding sources is particularly important for drug trials as the body of evidence may be dominated by studies funded by the makers of the drugs being tested.
In 2012, more rigorous reporting standards for Cochrane Reviews were introduced, including the reporting of trial funding sources and author–industry financial conflicts of interest. Reporting of funding sources for some or all included trials has now improved from 30% in Cochrane reviews of drug trials (as concluded in 2012) to 84% in recently published Cochrane meta-analyses. Only 15% of non-Cochrane reviews reporting funding sources for included trials, according to the recent study.
“Cochrane has made tremendous strides in this area,” said Kimberly Turner, the first author of the study. “with far more transparent reporting than even the top-ranked medical journals” (see 2020 study). Brett Thombs, the study’s senior author, added, “Cochrane is a standard setter in evidence synthesis. We hope that Cochrane will continue to focus on improving transparency in its reviews and that this will influence others to do the same.”
Karla Soares-Weiser, Editor in Chief of the Cochrane Library, commented, “Research integrity is the foundation on which our credibility rests and whilst we are proud of the conclusions this study draws, we know we have more work to do. Transparency is critical for trust and we’re committed to pushing forward our policies around conflicts of interest. This study focused on transparency about financial conflicts of interest, however later this year we will be implementing our revised conflict of interest policy, which further strengthens our rules for minimizing conflicts of interest in our own reviews.”
Representatives of four Cochrane Centres in Europe have signed an open letter to the European Medicines Agency (EMA) initiated by the German Institute for Quality and Efficiency in Health Care (IQWIG).
The letter – which Cochrane Austria, Cochrane France, Cochrane Germany and Cochrane Ireland have signed – calls on the EMA to publish clinical study reports on all drugs and vaccines for COVID-19 in full and immediately on the date of marketing authorisation.
Clinical study reports (CSRs) are detailed study documents that pharmaceutical companies provide to regulators such as the EMA as part of the drug approval process. In these reports, which are often thousands of pages long, manufacturers document in detail their clinical studies on the efficacy and risks of new active ingredients. CSRs also contain details on the design, methods and results of the study, down to the level of anonymised data of individual study participants. CSRs are therefore by far the most comprehensive information about a clinical trial.
The open letter, addressed to EMA Executive Director Prof Guido Rasi, highlights how the international research community has joined forces to identify or develop, test and evaluate drugs and vaccines to combat the pandemic. It states: “To assess these products further and to accelerate the development of additional products, the fast and full public availability of the information submitted to regulators is of utmost importance. In recent years, the EMA has been a pioneer in data transparency among regulatory agencies. It is exactly this transparency that is currently needed”.
Jörg Meerpohl, who signed the letter as director of Cochrane Germany and the Institute for Evidence in Medicine at the University Hospital of Freiburg, said: “Clinical study reports contain all relevant data on a study. They can be an important data source for systematic reviews. That is why Cochrane has long been campaigning for access to these documents”.
“In the current pandemic, great hopes are placed on research and industry to develop rapidly effective drugs for the treatment of COVID-19 and safe vaccines against infection with the causative virus SARS-CoV-2. In order for clinical research on COVID-19 to be independently reviewed and evaluated, transparency is needed regarding planned and conducted studies and access to the detailed study results. This includes access for independent scientists to clinical study reports”.
The EMA has recently launched an accelerated approval procedure for the antiviral drug remdesivir.
Cochrane has submitted a statement to the 73rd World Health Assembly, which is taking place virtually this week (18 and 19 May).
The World Health Assembly (WHA) is the decision-making body of the World Health Organization (WHO) and is attended by representatives of all Member States. This year’s WHA focuses on the COVID-19 pandemic.
Our statement highlights the value of evidence-informed health policy and, given the large volume of COVID-19-related research underway, calls for Member States to ensure trial transparency and to support evidence synthesis.
The full statement is below:
The COVID-19 pandemic highlights the critical importance of evidence-informed global health policy. Governments, healthcare professionals and researchers around the world are seeking answers to questions related to the treatment of patients, and how best to protect healthcare workers and the public.
Cochrane is a global leader in the production of high-quality synthesized evidence to inform health decision making. We are working closely with WHO by producing rapid reviews to answer priority questions related to COVID-19, thus supporting the development of effective guidance, treatments and cost-efficient responses to the pandemic.
However, the volume and variable quality of COVID-19-related research being published represents a huge challenge to synthesize their results accurately. Cochrane has identified over 4,000 COVID-19 human studies already ongoing or published; and has launched and will maintain one of the largest and most sophisticated registries of COVID-19 studies as well as a living synthesis of COVID-19 study results which is informing the WHO’s ‘Research and Development Blueprint’. Cochrane is also producing relevant ‘living systematic reviews’ that allow for continuous updates as new studies become available.
In the coming years billions of dollars will be spent on COVID-19 clinical trials. But we know that many clinical trials are never registered or reported on: a phenomenon which is seriously hampering decision making on best available evidence. Now, more than ever, it is vital that WHO’s guidance on public disclosure of results from clinical trials is followed. Without accessible trial data, and proper synthesis and appraisal, it is certain that much of this global research investment will be wasted.
We call on WHO member states to support evidence-informed decision making by taking action to safeguard trial transparency; and to provide adequate funding for evidence synthesis given the challenges ahead.Monday, May 18, 2020
To help reduce the spread of COVID-19, workers in many countries have changed their usual work habits and are working from home where feasible. Home working often involves prolonged sitting and working at a computer.
This Special Collection, developed in collaboration with Cochrane Work, brings together Cochrane Reviews summarizing evidence for maintaining health and wellbeing when working from home due to the COVID-19 pandemic. It includes systematic reviews that evaluate the effects of interventions related to maintaining physical activity, optimizing the work environment, and preventing musculoskeletal and eye problems.
Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications
Older people are often prescribed multiple medications, which can be challenging to manage and may lead to under-use or over-use of medication or medication-taking errors.
Review authors asked, “What are the best ways to help older adults who have been prescribed multiple medications to use and take their medications”.
The review authors identified 50 studies, with 14,269 participants. Studies tested educational interventions, behavioural interventions, or both, to assess improve medication-taking ability or medication adherence, or both. All the studies compared the interventions to usual care; and six studies also compared the intervention to another intervention as well as usual care.
Examples of "behavioral interventions" are multi-compartment dose-administration aids, simplifying the medication regimen (e.g. reducing number of dosing times per day), motivational interviewing, ongoing follow-up/support. "Educational interventions" include medication counselling with or without a review of medications (e.g. at the time of hospital discharge, at the time of dispensing)
These could be delivered individually or in combination by pharmacists and/or nurses.
The review authors did not identify any studies that assessed educational or behavioural interventions alone for medication-taking ability. Five mixed intervention studies used different measures of medication-taking ability, so the review authors could not determine the effects.
Behavioural-only and mixed interventions may improve adherence, but the effects of educational-only interventions are uncertain.
Mixed interventions may reduce the number of emergency department visits or hospital admissions and may lead to little or no change in health-related quality of life. Educational interventions alone probably have little or no effect on emergency department or hospital admissions, or health-related quality of life. The effects of behavioural interventions alone on emergency department or hospital admissions and health-related quality of life are uncertain. The effects of behavioural, educational, or mixed interventions on mortality are unclear.
The studies identified were very different in terms of what interventions people received, where interventions were delivered, and how and when studies measured people’s medication-taking ability or adherence. Due to these differences and problems with how the trials were conducted, the review authors considered the quality of the evidence to be low or very low overall.
Further high-quality studies are necessary to identify the most effective way to improve medication-taking ability and medication adherence among older adults prescribed multiple medications.
The Governing Board is pleased to announce the appointment of Tracey Howe as Co-Chair and Karen Kelly as a new member
Governing Board Co-Chair: Tracey Howe
Cochrane’s Governing Board has appointed Professor Tracey Howe as its new Co-Chair from 1st September 2020. She will work alongside fellow Co-Chair Catherine Marshall, and replace Martin Burton, who will be stepping down in August, after serving six years on the Board, three as Co-Chair.
Professor Howe is Director of the Cochrane-Campbell Global Ageing Partnership and is based in Glasgow, UK. She was elected as a Governing Board member (Trustee) in July 2017, served as Treasurer from October 2018 to March 2019, and is a member of the Board’s Governance, and Finance Audit & Investment Committees.
Outside Cochrane, Tracey works with the World Health Organization on the decade of Healthy Ageing 2020-30 and has previously been involved on various committees of the National Institute for Clinical Excellence in England, and the Scottish Intercollegiate Guidelines Network. In addition, she has worked extensively with the Cochrane Consumer Network since 2003, and as a Cochrane author, editor and former Co-ordinating Editor. She has experience in public engagement and knowledge translation, championing the consumer voice in health care, disseminating research into practice and initiating, driving and delivering large-scale science communication to the public - including the achievement of a Guinness World Record for the largest hand hygiene lesson involving over 5,500 children, 60 primary schools and 160 student nurses in Glasgow.
Co-Chair, Catherine Marshall says: “Tracey has been an active member on Cochrane’s Governing Board and of organizations at all levels from local community initiatives through to European-based charities. Tracey has experience in leading international collaborative partnerships and these experiences will be a significant asset to Cochrane. I look forward to working with her as Co-Chair of the Governing Board from September 2020. The Board has greatly appreciated Martin Burton’s contribution as Co-Chair and will have time to recognize his valuable contribution in the coming months.”
Of her appointment, Tracey, says: “It is a great privilege and honor for me to be named as Co-Chair of the Board of Cochrane, which has such an incredible history and esteemed reputation. I am excited to work alongside Co-Chair Catherine Marshall to lead our talented and strategic-minded Board, senior management team and wider incredible global Cochrane community who have such strong skills and depth of experiences in producing and disseminating high-quality, relevant and up-to-date synthesized research evidence that informs health and health care.”
Governing Board member: Karen Kelly
The Board has also appointed Karen Kelly as a Trustee for Cochrane. Karen has had a successful career as an accountant and financial leader in the public sector and since leaving full time employment in 2012, has been developing her interests in a wider range of organizations through consultancy, training and non-executive roles. She currently holds three other board positions with a National Health Service board, a Further Education College, and a national charity. All these organizations are based in Scotland, and Karen is excited to add to her portfolio by joining Cochrane, with its much wider geographical reach.
Karen brings extensive experience in financial management, UK governance, and strategic planning to complement the diverse skillsets of other Board members. Her appointment is for three years, starting immediately. The Board is delighted to welcome her.
Members of the Governing Board can be contacted at firstname.lastname@example.orgThursday, May 14, 2020
People who have recovered from COVID-19 develop natural defences to the disease in their blood (antibodies). Antibodies are found in part of the blood called plasma. Plasma from blood donated from recovered patients, which contains COVID-19 antibodies, can be used to make two preparations. Firstly, convalescent plasma, which is plasma that contains these antibodies. Secondly, hyperimmune immunoglobulin, which is more concentrated, and therefore contains more antibodies.
Convalescent plasma and hyperimmune immunoglobulin have been used successfully to treat other respiratory viruses. These treatments (given by a drip or injection) are generally well-tolerated, but unwanted effects can occur.
The review authors wanted to know whether plasma from people who have recovered from COVID-19 is an effective treatment for people with COVID-19, and whether this treatment causes any unwanted effects.
The authors searched major medical databases for clinical studies on treatment with convalescent plasma or hyperimmune immunoglobulin for people with COVID-19. Studies could be conducted anywhere in the world and include participants of any age, gender or ethnicity, with mild, moderate or severe COVID-19.
The review includes eight completed studies, with 32 participants who received convalescent plasma. None of the studies randomly allocated participants to different treatments (randomised trials produce the best evidence). None of the studies included a group of people who did not receive convalescent plasma, as a comparison group.
Certainty (confidence) in the evidence is very limited because the studies were not randomised and did not use reliable methods to measure their results. Furthermore, they had only a small number of participants, who received various treatments alongside convalescent plasma, and some had underlying health problems.
The authors are very uncertain whether plasma from people who have recovered from COVID-19 is an effective treatment for people with COVID-19. The completed studies the authors found were poor quality and their results could be related to the natural progression of the disease, other treatments that the participants received, or to convalescent plasma.
Lead author, Sarah Valk from the Center for Clinical Transfusion Research at Sanquin Blood Supply in the Netherlands, says: "In summary, the information from the studies that were available in late April 2020 means that we remain very uncertain about the effectiveness and safety of using convalescent plasma for people with COVID-19. Despite extensive searching, we were only able to include very low-quality evidence, from small uncontrolled studies, in which the participants received many other treatments. Different outcome measures were reported and we cannot know if recovery was due to the treatment or the natural course of the disease."
"However, this field is changing rapidly. We identified approximately 50 on-going studies, of which 22 are randomized trials and, so, we will be updating this review periodically, as a 'living systematic review', so that it reflects the most current, available evidence."
The COVID-19 pandemic has resulted in the closure or reduction of dental services across the world. Now, attention is focused on planning the re-opening and restructuring of dental services.
To support decision making, a group led by Professors Jan Clarkson and Craig Ramsay conducted a rapid review of internationally produced guidance for re-opening dental services.
The review group comprised researchers and clinicians from a range of UK institutions including the Scottish Dental Clinical Effectiveness Programme, NHS Education for Scotland, the Universities of Aberdeen, Dundee and Manchester, and Cochrane Oral Health.
Professor Clarkson explained, “There is now an urgent need to map out how dental services are to return to providing wider patient care. Given that we have only really known about COVID-19 for about 120 days, robust evidence to inform how to approach re-opening is scarce or non-existent.
The same concerns exist across the world and therefore we decided to formally review the recommendations being produced in different countries as a resource for decision makers.”
Professor Ramsay added, “We identified sources from eleven countries and found relevant recommendations fell into five themes: practice preparation, personal protective equipment, management of the clinical area, dental procedures, and cleaning and disinfection. The review collates the range of recommendations related to each theme from the various sources identified. I would like to stress that this review is not guidance but, in the absence of robust evidence, it should assist policy and decision makers in producing national guidance for their own settings.”
Jan Clarkson added “Conducting this review has been a hugely collaborative international effort and I am extremely grateful to all those involved for working so hard to complete it in such short time.”
Hours: Part Time - up to two days per month
The vision of Campbell is to bring about positive social change, and to improve the quality of public and private services around the world, by preparing, maintaining and disseminating systematic reviews of existing social science evidence in education, crime and justice, social welfare, and international development.
The International Development Coordinating Group (IDCG) was established as part of Campbell Collaboration in May 2011 to support the production of systematic reviews of social and economic development interventions in low- and middle-income countries. The group provides editorial services and methodological guidance, fosters collaboration in the production of systematic reviews and builds the capacity of authors and policymakers to conduct and use systematic reviews. Till date the IDCG has produced more than 50 publications.
The group has an increasing portfolio of reviews across a range of sectors, from governance to agriculture and social protection.
We are currently recruiting an Editor to support our work to produce high quality, policy relevant syntheses recruiting a new Editor to help support the production of high-quality systematic reviews of relevance to low-and-middle income countries. The IDCG secretariat is based at the 3ie London Office.
Role and responsibilities
Coordinating Group (CG) Editors are responsible for providing substantive and methodological feedback to authors preparing a review under the auspices of the respective CG, consolidating feedback from external peer reviewers and the Campbell Methods Editor, and suggesting how authors can effectively respond to the feedback they have received.
Their responsibilities are as follows:
- Provide substantive comments and suggest changes as deemed appropriate for titles, protocols, and completed reviews as they are submitted by authors;
- Select external peer reviewers in coordination with the Managing Editor and with input consultation as needed from the CG Co-Chairs and Advisory Board;
- In coordination with the Managing Editor, transmit submitted protocols and reviews for assessment by the Campbell Methods Editor;
- Integrate comments from external peer reviewers and methods reviewers into a clear set of changes that need to be addressed by the authors (i.e., write “action letters”);
- Evaluate authors’ revisions to protocols and reviews and determine if they adequately address the concerns of the external peer reviewers and methods reviewers;
- Submit completed title registrations, protocols, and systematic reviews, with recommendations for approval or rejection, to the CG Co-Chairs for their approval prior to review by the Editor-in-Chief.
- To adhere to COPE guidelines (Committee on Publication Ethics) and to participate in bimonthly calls with Cambell editors about methodological standards and processes
Experience and qualifications
- Post-graduate degree in economics, development studies, political science, public health, statistics or other relevant social science.
- Knowledge and experience with systematic reviews, demonstrated through publication of at least one systematic review is essential
- Excellent writing skills in English
- Attention to detail.
- Knowledge of international development policies and programs
- Experience with editorial work for international journals an advantage.
Terms and conditions
The Editor role is a paid position for up to two days a month and provides a great opportunity for professionals to gain exposure to the work of IDCG and contribute to the production of more and better systematic reviews on policy relevant topics.
If you are interested in this role please send your CV and cover email to: email@example.com with IDCG Editor in the subject heading
Telehealth refers to the provision of personalized health care over a distance. It embraces synchronous and asynchronous interactions including consulting by phone, instant messaging, video, text message, or web-based services. Telehealth consists of three main elements: the patient provides data about their health; data is transferred to the healthcare professional electronically; and the healthcare professional uses their clinical skills and judgment to provide personalized feedback to the patient. While telehealth has much to offer in the provision of remote care to patients, accessing it may prove a significant challenge to those most in need, including older people, those from socio-economically disadvantaged backgrounds, and those with physical or learning disabilities.
This Special Collection includes Cochrane Reviews that address using telehealth to support clinical management of various conditions, including asthma, diabetes, cardiovascular disease, dementia, reproductive health, and skin cancer. It includes reviews of using telehealth to provide carer and parent support as well as empowering patient self-management of their long-term conditions. For reviews related to quitting smoking during the pandemic, you can refer to Coronavirus (COVID-19): effective options for quitting smoking during the pandemic.
- Read Coronavirus (COVID-19): remote care through telehealth
- mHealth evidence summaries for decision makers - the use of mobile phones and tablets to organise health care, provide services, and communicate with clients, patients, and the public. Created by Cochrane Effective Practice and Organizational of Care, these short summaries of Cochrane reviews look at implementation considerations.
- Read Cochrane evidence related to COVID-19
Dear Community colleagues,
With the deepest disappointment and regret I have to inform you that as a result of the continued spread and impact of the COVID-19 (coronavirus) across the world, Cochrane’s 27th Colloquium in Toronto, Canada, between 4th-7th October this year has been cancelled.
Cochrane’s Governing Board has concluded, with the agreement of Cochrane Canada, that the most appropriate decision is to cancel the Toronto Colloquium in its entirety for 2020 and hold it instead in the Canadian Fall of 2022 following Global Evidence Summit 2 taking the place of our annual Colloquium in Prague in 2021. We are looking at availability options at the same conference venue, the Westin Harbour Castle Hotel in Toronto, and we hope to secure dates within the coming weeks.
In addition, the Board also concluded that there should be no ‘virtual’ Colloquium or hybrid programme this year. Given the extraordinary circumstances we are all living through, the uncertainties around how the pandemic will develop and its ongoing impact, and the continuing pressures imposed on all Cochrane’s Groups and its Central Executive Team in working on our COVID-19 response as well as critical ‘Business as Usual’ activities, the Board decided that trying to plan any kind of event in the coming months would put unnecessary pressure on the organization.
However, we will edit and publish the accepted abstracts submitted for this year’s Colloquium in the Cochrane Library. The Colloquium organizers received 639 abstracts and the relevant committees will continue to review and respond to those submissions in the next few weeks. As a Central Executive Team, we will also provide you with opportunities for imaginative ideas on how parts of our community could easily organize ‘social events’ and how continued learning initiatives could be implemented to help bind us together, given that by October 2020 many members and supporters will not have met together for two years.
This is extremely disappointing news for all of us, but particularly for the Cochrane Canada organizers, the members of all of the Colloquium-related committees and many others who have been working so hard on the Colloquium preparations. The Board and the Senior Management Team would like to recognize the extraordinary efforts of Holger Schünemann, Dawn Cattapan and the rest of the Cochrane Canada team; and we are sure we will be able to build successfully on the work accomplished so far to ensure that the Toronto Colloquium in 2022 will be everything we anticipated it would be later this year: a world-class scientific event and a memorable gathering of the Cochrane community in one of the world’s most vibrant, multi-cultural cities.
Thank you for your ongoing support and commitment to Cochrane and its work; and I hope that all of you remain safe and well during these extraordinary times.
With my warmest best wishes,
Mark G. Wilson
Chief Executive Officer
Salary: £35,965 to £43,470 The appointment will be on UCL Grade 7, per annum, inclusive of London Allowance.
Hours: Full Time
Contract Type: Fixed-Term/Contract
Closes: 26th May 2020
Job Ref: 1866740
The Fellow will be supporting the activities and provide support to complex systematic reviews across the 5 groups of the Circulation and Breathing Network.
Performing and Provide support to complex systematic reviews, namely network meta-analyses, diagnostic accuracy reviews and prognostic reviews.
This position is open to anyone who meets the requirements described below and is funded until 06 February 2021 in the first instance.
The candidate should have proven experience on evidence of authorship of at least one network meta-analysis.
Previous experience of systematic reviews, ideally using Cochrane methodology.
Applicants should apply online. To access further details about the position and how to apply please click here
Applications will be reviewed by the Editor in Chief, the Deputy Editor in Chief, and the Network Senior Editors.
Interested candidates are welcome to contact Dr Rui Providencia ( firstname.lastname@example.org ) for an informal discussion.
If you have any queries regarding the application process, please contact IHI HR ( email@example.com).
The UCL Ways of Working for professional services supports colleagues to be successful and happy at UCL through sharing expectations around how we work – please see www.ucl.ac.uk/ways-of-working to find out more.
We particularly welcome applications from black and minority ethnic candidates as they are under-represented within UCL at this level.
We will consider applications to work on a part-time, flexible and job share basis wherever possible.
Our department holds an Athena SWAN Bronze award, in recognition of our commitment to advancing gender equality.
- For further informationand how to apply, click here
- Deadline for application: 26th May 2020
- Interviews to be held on: tbc
Some infectious diseases are spread by airborne droplets from coughs and sneezes, which can infect people who touch contaminated skin or surfaces. Washing hands with soap and water may prevent these diseases from spreading. People with no soap may use other materials like ash, mud, soil with or without water, or water alone, to clean their hands. Hand cleaning with ash (the solid remains from cooking stoves and fires) might work by rubbing away or inactivating the virus or bacteria. However, chemicals in the ash could also damage the skin.
If ash is an effective hand cleanser, it could reduce the spread of coronavirus (COVID‐19) and other infectious diseases in low‐income areas where soap is not widely available.
In this Cochrane Rapid Review, authors wanted to know whether people who use ash for hand cleaning are more or less likely to catch infectious diseases than people who use soap, water, mud or soil, or who do not clean their hands. They also wanted to know whether using ash causes unwanted effects, like sore hands or a rash.
Authors looked for studies that examined hand cleaning with ash compared with soap, mud, soil, water only or no hand cleaning. To answer these questions, the studies could include adults and children and take place anywhere.
COVID‐19 is spreading rapidly, so the authors needed to answer this question quickly. This meant they shortened some steps of the normal Cochrane Review process. They could not find the full texts of five potentially relevant studies, or contact study authors for additional data. Although they searched several databases, they may have missed some studies. The authors plan to include all relevant information in a future version of the review.
The authors identified 14 studies that assessed ash for hand cleaning. This review includes evidence published up to 26 March 2020. Only one small study directly compared people chosen at random to use ash or soap or other materials (randomised studies produce the best evidence). The studies included people of all ages and mainly took place in low‐income, rural communities. Six studies provided information to help answer our question.
One study investigated children who had been to hospital with diarrhoea compared with children who had not. Study authors looked at the hand washing area in the children’s houses to see how they cleaned their hands. They found that families that used ash for hand cleaning made a similar number of hospital visits for children with diarrhoea as those families that used soap.
Another study investigated whether women with unusual vaginal itching or discharge were more likely to clean their hands with ash than women who had not experienced such symptoms. They found that women who used ash and water for hand cleaning were as likely to experience vaginal itching or discharge as those women who used soap.
Four studies measured bacteria on hands after using ash, soap, water, mud or no hand cleaning. The authors are uncertain about the effect of ash compared with other materials for hand cleaning on bacteria on people’s hands because the studies used unreliable methods and their results were unclear.
None of the studies provided information about the severity of infectious diseases, whether people used ash or another material consistently, the number of deaths, or unwanted effects due to hand cleaning with ash.
The certainty (confidence) of the evidence was limited because the authors found few studies; those they did find had unreliable methods and different kinds of participants, and none of the studies we found reliably examined whether participants got infections.
The authors are uncertain whether hand cleaning with ash compared with hand cleaning with soap, water, mud, soil or no hand cleaning stops or reduces the spread of viral or bacterial infections. They do not know if hand cleaning with ash causes unwanted effects.
- Read the full Cochrane Review
- Listen to the podcast here
- Learn more about Cochrane's work on Rapid Reviews
- View resources and news about Cochrane's response to the COVID-19 pandemic
Tuesday, April 28, 2020
Job title : Managing Editor
Job reference : REQ004899
Application closing date : 21/05/2020
Location : Preston Campus, UK
Salary : Grade: I (£44045 - £51034)
The School of Medicine wishes to appoint a Managing Editor who will be based at UCLAN Preston campus but will be expected to work collaboratively with the wider study team internationally employing IT solutions to achieve this. This role will involve the primary managing editor role for the Cochrane Gut group satellite in UCLAN. The group has a portfolio of 120 reviews, 40 protocols and 25 titles at present. This covers IBD management in adults and children, excluding microbiome focussed works. Additionally, the children 0 functional bowel portfolio. Through collaboration with the Cochrane Gut group in Canada, we will also lead editorial for all reviews authored by their editors and vice versa, involving work on a wider Gut portfolio.
There will be a significant volume of research output and scholarly content to be produced by the post holder themselves, as well as facilitating the wider team. Expect 30-40 full reviews per annum to be completing editorial as a minimum during this period of rapid updating and reprioritisation, as well as 20-30 protocols, associated positions pieces, editorials and patient / servicer user materials. The post holder will have to work highly efficiently, communicating in a timely and effective manner with the CEs and colleagues. There will also likely be educational and dissemination activities with various stakeholders and patients on a regular basis.
With experience of systematic review work and specific Cochrane experience, you will have knowledge and understanding of the work of Cochrane Collaboration and the nature of systematic reviews. Experience of Cochrane editorial roles and dissemination and presentation of such works is also essential.
You will have postgraduate training in an appropriate field to at least Masters level, including epidemiology, public health and medical specialities. A PhD or Professional Doctorate qualification are not essential requirements, but would be desirable.
You must possess excellent communication skills; have an ability to work within a multidisciplinary team and show initiative and innovation. With a professional and flexible approach, you will have a commitment to the missions and values of the University.
Informal enquiries are welcomed - please contact Morris Gordon, Head of Professionalism and Careers, via email in the first instance firstname.lastname@example.org
Applicants need to meet all essential criteria on the person specification to be considered for interview. This position is based in Preston with travel required.
Job title : Information Specialist (Part time)
Job reference : REQ004898
Application closing date : 21/05/2020
Location : Preston Campus
Salary : Grade: F (£25941-30046) pro-rata
The School of Medicine wishes to appoint an Information Specialist who will be based at UCLAN Preston campus but will be expected to work collaboratively with the wider study team internationally employing IT solutions to achieve this. The post holder will provide Cochrane review authors with comprehensive literature searching support; maintaining and developing the Group's' Specialised Register within the Cochrane Register of Studies (CRS). You will also contribute to the development of CENTRAL and support the output of high-quality Cochrane reviews working closely with the Managing Editor and Coordinating Editors.
You will have a first degree or postgraduate qualifications in Library/Information Management and good analytical and IT skills. You will have previous experience of searching online bibliographic databases and document management such as MEDLINE and Embase. A high level of editing and writing skills is also essential to this role. You will have experience of undertaking systematic reviews and health technology assessments.
You must possess excellent communication skills; have an ability to work within a multidisciplinary team and have excellent planning and organisational skills. With a professional and flexible approach, you will have a commitment to the missions and values of the University.
Informal enquiries are welcomed - please contact Morris Gordon, Professor of Evidence Synthesis and Systematic Review, via email in the first instance email@example.com
Applicants need to meet all essential criteria on the person specification to be considered for interview. This position is based in Preston, UK.
Please apply online via www.uclan.ac.uk/jobs or by contacting Human Resources on 01772 892324 and quoting the reference number. CVs will not be considered unless accompanied by a completed application form.
Applicants need to meet all essential criteria on the person specification to be considered for interview. This position is based in Preston.
Specifications: Part time (0.4 FTE), 15 hours per week
Salary: £30,000 FTE per annum
Location: Flexible – coverage of UK morning timezone preferred
Application Closing Date: 20th May 2020
This role is an exciting opportunity to use your experience to make a difference in the field of health care research.
Cochrane’s Community Support team is the first point of contact for the international Cochrane community. We provide a timely and coordinated support service, resolving queries covering a broad range of areas including Cochrane Account login, Cochrane review software (e.g. RevMan Web, Archie), membership, training, websites, sales and research. The Community Support Officers are the day-to-day face of the team answering many queries and escalating complex enquiries appropriately.
This team sits within the People Services department, which 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 customer service, including excellent interpersonal communication skills; a courteous, professional manner; and the ability to manage complaints with diplomacy and resilience
- Proactive and flexible approach to learning new systems and products in order to provide the best possible customer support
- Experience with software and systems related to customer service, such as HappyFox, Jira, SugarCRM and MailChimp
- Excellent English-language communication skills (both verbal and written), including experience in communicating technical content, tailoring standard communications to individual requirements, and working with people from a variety of cultural and linguistic backgrounds
- Good 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.
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Collaborators from at least seven countries have compiled living evidence related to COVID-19 for use by clinicians, policymakers, researchers, guideline developers. Led by collaborators from Cochrane France, Cochrane Germany, Cochrane Ireland, the Cochrane Bias Methods Group and others, this project brings together the latest evidence related to COVID-19, presenting data on trials registered all over the world, as well as living evidence synthesis of results from these trials. The project provides one location for decision makers to access information on COVID trials and synthesized results that is frequently updated by independent researchers with expertise in evidence synthesis. The project includes two main parts: living mapping of ongoing research followed by living synthesis of study results as soon as they are available.
Living map of ongoing research
To provide a living map of ongoing research, the research team searches clinical trial registries and records data to compile registered study characteristics. This feeds into their data visualizations and mapping of registered studies developed in collaboration with research teams from the CNRS. These provide easy ways to see the status of COVID-19 studies based on country in which they are taking place, study design, disease severity in study participants, and type of treatment being studied, as well as network maps of these studies.
This is useful for researchers planning clinical trials, to easily see where there is a gap in evidence, or for research funders deciding where to dedicate resources for future clinical trials.
Living synthesis of study results
The living systematic reviews of COVID-19 study results completed by the project focuses on three areas: pharmacologic treatments, ICU supportive treatments, and preventive treatments. For each, as results are available, the team synthesizes these results, providing a list of treatment comparisons, a summary of the evidence for that comparison, and a detailed description of primary studies, including a risk of bias assessment.
Soon they hope to have a full Summary of Findings table available for each treatment comparison. Particularly useful for clinicians and healthcare decision-makers, the team’s goal is to update these living systematic review of study results twice per week. They will also share their database to allow researchers, decision makers, guideline developers perform their own analysis.
Isabelle Boutron and Philippe Ravaud, project leaders, say of the project: “We are proud of the interdisciplinary and international nature of this collaboration, which we believe provides an important source of high-quality synthesis of all COVID-19 evidence underway.”
Karla Soares-Weiser, Editor in Chief of the Cochrane Library, says, “We are impressed by the work that this project has produced so far. As the COVID-19 pandemic continues and global research on this disease increases daily, there is an ever-growing need for living evidence synthesis. We are pleased to be collaborating with this team, working together to continue responding to this crisis and planning our next steps for living evidence synthesis.”
Monday, April 20, 2020
Factors that influence whether healthcare workers follow infection prevention and control guidelines for respiratory infectious diseases
Coronavirus (COVID-19) is a new respiratory infectious disease that has spread quickly throughout the world. Healthcare workers treating patients with COVID-19 are at risk of infection themselves through droplets from coughs, sneezes or other body fluids from infected patients and contaminated surfaces.
This review is one of a series of rapid reviews that Cochrane contributors have prepared to inform the 2020 COVID-19 pandemic. The aim of this Cochrane review of qualitative research (“qualitative evidence synthesis”) is to explore factors that influence whether healthcare workers follow infection prevention and control (IPC) guidelines for respiratory infectious diseases. To answer this question, the authors searched for and analysed qualitative studies about this topic.
Healthcare workers point to several factors that influence their ability and willingness to follow IPC guidelines when managing respiratory infectious diseases. These include factors linked to the guideline itself and how it is communicated, support from managers, workplace culture, training, physical space, access to and trust in personal protective equipment (PPE), and a desire to deliver good patient care. The review also highlights the importance of including all facility staff, including support staff, when implementing IPC guidelines.
When respiratory infectious diseases become widespread, such as during the COVID-19 pandemic, healthcare workers’ use of IPC strategies become even more important. These strategies include the use of PPE such as masks, face shields, gloves and gowns; separating patients with respiratory infections from others; and stricter cleaning routines. Exploring how healthcare workers view and experience these strategies can help authorities and healthcare facilities learn more about how best to support healthcare workers to implement them.
The authors found 36 relevant studies and sampled 20 of these studies for analysis. Ten studies were from Asia, four from Africa, four from North America and two from Australia. The studies explored the views and experiences of nurses, doctors and other healthcare workers when dealing with SARS, H1N1, MERS, tuberculosis, or seasonal influenza. Most of these healthcare workers worked in hospitals; others worked in primary and community care settings.
The review pointed to several factors that influenced healthcare workers’ adherence to IPC guidance. The following factors are based on findings assessed as of moderate to high confidence.
- Healthcare workers felt unsure when local guidelines were long, unclear or did not match national or international guidelines. They could feel overwhelmed because local guidelines were constantly changing. They also described how IPC strategies led to increased workloads and fatigue, for instance because they had to use PPE and take on additional cleaning. Healthcare workers described how their responses to IPC guidelines were affected by the level of support they felt they received from their management team.
- Clear communication about IPC guidelines was seen as vital. But healthcare workers pointed to a lack of training about the infection itself and about how to use PPE. They also thought it was a problem when training was not compulsory.
- Having enough space to isolate patients was seen as vital. Too few isolation rooms, anterooms (small rooms leading from a corridor into an isolation room) and shower facilities was a problem. Other important practical measures described by healthcare workers included minimising overcrowding, fast-tracking infected patients, restricting visitors, and providing easy access to handwashing facilities.
- A lack of PPE, or PPE that was of poor quality, was a serious concern for healthcare workers and managers. They also highlighted the need to adjust the amount of supplies as infection outbreaks continued.
- Healthcare workers believed that they followed IPC guidance more closely when they saw the value of it. Other healthcare workers felt motivated to follow the guidance because of fear of infecting themselves and their families, or because they felt responsible for their patients. Some healthcare workers found it difficult to use masks and other equipment when it made patients feel isolated, frightened or stigmatised. Healthcare workers also found masks and other equipment uncomfortable to use. The workplace culture could also influence whether healthcare workers followed IPC guidelines or not.
- Across many of the findings, healthcare workers pointed to the importance of including all staff, including cleaning staff, porters, kitchen staff and other support staff when implementing IPC guidelines.
- Read the full Cochrane Review
- Evidence Summary for ministries of health, healthcare facilities and other stakeholders to plan, implement and manage IPC strategies for respiratory infectious diseases (also available in Spanish, Portuguese, and Norwegian)
- Visit the Cochrane Effective Practice and Organisation of Care website
Read all the Cochrane resources and news on COVID-19
New evidence published in the Cochrane Library today finds MMR, MMRV and MMR+V vaccines are effective and that they are not associated with increased risk of autism.
Measles, mumps, rubella and varicella (also known as chickenpox) are infectious diseases caused by viruses. They are most common in children and young adults, and can lead to potentially fatal illnesses, disabilities and death. Measles remains one of the leading causes of childhood death around the globe. Rubella is also dangerous for pregnant women, as it can cause miscarriage or harm to unborn babies.
The MMR (measles, mumps, rubella) is a combined vaccine that protects against all three infections. Clinicians can vaccinate against varicella (chickenpox) by a combined MMR and varicella vaccine (MMRV) or giving it separately at the same time (MMR+V).
‘We wanted to assess the effectiveness, safety, and long- and short-term harms of the MMR vaccines in this updated review which was last updated in 2012,’ explains lead author, Dr Carlo Di Pietrantonj of Italy’s Regional Epidemiology Unit SeREMI. ‘From the 138 randomised and non-randomised studies included in the review, 51 studies (10 million children) assessed how effective the vaccines were at preventing the diseases, and 87 studies (13 million children) assessed harms’
In terms of effectiveness the review found:
- Measles: one dose of vaccine was 95% effective in preventing measles. Based on the data analysed in the review, the number of cases would fall from 7% in unvaccinated children to under 0.5% in children who receive one dose of the vaccine. After two doses, effectiveness was similar at around 96%.
- Mumps: one dose of vaccine was 72% effective in preventing mumps. This rose to 86% after two doses. From data analysed in the review. the number of cases would fall from 7.4% in unvaccinated children to 1% in children were vaccinated with two doses.
The results for rubella and chickenpox also showed that that vaccines are effective. After one dose of vaccine was 89% effective in preventing rubella, and one study found that after 10 years the MMRV vaccine was 95% effective at preventing chickenpox infection. If exposed to chickenpox, 5 out of 100 vaccinated children would catch it.
‘In terms of safety, we know from previous studies all around the world that the risks posed by these diseases far outweigh those of the vaccines administered to prevent them,’ says Dr Di Pietrantonj. ‘In this review, we wanted to look at evidence for specific harms that have been linked with these vaccines in public debate - often without rigorous scientific evidence as a basis.’
In relation to the controversy arising from false claims linking vaccination and autism, the review summarises evidence from two studies with 1,194,764 children. Diagnosed cases of autism were similar in vaccinated and unvaccinated children.
Two further studies with 1,071,088 children find no evidence for any association between the MMR vaccines and encephalitis, inflammatory bowel disease, Crohn's disease, cognitive delay, type 1 diabetes, asthma, dermatitis/eczema, hay fever, leukaemia, multiple sclerosis, gait disturbance and bacterial or viral infections.
‘We judged the certainty of the evidence for the effectiveness of the MMR vaccine to be moderate. Although the studies that provide these data are not randomised the effects are very large. The certainty of the evidence for the varicella vaccine, based on an RCT, was judged to be high.’ says Di Pietrantonj.
‘Overall we think that existing evidence on the safety and effectiveness of MMR/MMRV/MMR+V vaccines supports their use for mass immunisation. Campaigns aimed at global eradication should assess epidemiological and socioeconomic situations of the countries as well as the capacity to achieve high vaccination coverage. More evidence is needed to assess whether the protective effect of MMR/MMRV could wane with time since immunisation.’
The COVID-19 pandemic has shown the connectedness and vulnerability of today’s world, and the need for solidarity and open collaboration across borders. Governments, health care professionals and researchers around the world are seeking answers to questions related to the treatment of patients, and how best to protect health care workers as well as the public at large. The World Health Organization (WHO) plays an essential role in supporting its Member States in the response to the pandemic, and in providing evidence-informed guidance to politicians and healthcare professionals on questions they are grappling with on a daily basis.
The announcement by the US government this week that it is suspending its member state contribution to the WHO is deeply disappointing. Cochrane believes nothing should be done now that undermines the collective action required for the world to overcome this major challenge to global health. While it is vital to monitor closely the behaviour and decisions of the WHO and other international institutions, and continually hold them to account, this is not the time for cutting funding to the WHO, which will damage its response to COVID-19 with potentially huge public health consequences, particularly for vulnerable people in Low- and Middle-Income Countries.
Cochrane is a global leader in the production of high-quality evidence to inform health decision making and a non-state-actor in official relations with WHO. During the current crisis, Cochrane is working closely with WHO to support its response to COVID-19. We are producing rapid reviews to answer priority questions related to the pandemic in a timely manner, thus supporting the development of WHO guidance based on the best available evidence.
We continue to support the WHO and condemn the personal attacks being leveled against its staff who are working hard - under extremely difficult circumstances - to tackle this crisis. We call on other members of the research community, civil society organizations and governments to do the same. The time for reflection and learning about the pandemic will come, and that evaluation should be done in a transparent and evidence-informed manner. In the meantime, collective action and mutual collaboration and support are the only ways to ensure that as many lives as possible are saved.
Martin Burton, Co-Chair, Cochrane Governing Board
Catherine Marshall, Co-Chair, Cochrane Governing Board
Mark Wilson, CEO, Cochrane
Karla Soares-Weiser, Editor in Chief, Cochrane LibraryFriday, April 17, 2020