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

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

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

Name: Filip Wikström
Location: Lund, Cochrane Sweden
CIM location: Barcelona, Cochrane Iberoamerica

How did you first learn about Cochrane?
The Cochrane Learning Modules are integrated into the Medicine Programme in Lund University, so I was gradually exposed to the Cochrane Methodology over several semesters. I think reading and assessing past research is an invaluable skill to have, so I was very glad to get the opportunity to do my Master’s Thesis with Cochrane.

What was your experience with Cochrane International Mobility?
My experience with the international mobility program was fantastic. The researchers at Cochrane Iberoamerica were very welcoming and I look back very fondly to the weeks I spent there. I learned a lot about systematic reviews but I also got to know amazing researchers and the projects they were working on.

What are you doing now in relation to your Cochrane International Mobility experience?
Currently I am contributing to a Cochrane Review on Tumor Necrosis Factor alpha inhibitors, under the supervision of Michele Compagno and Matteo Bruschettini (both based at Lund University). In the future I aspire to collaborate on more Cochrane projects.

Do you have any words of advice to anyone considering a Cochrane International Mobility experience?
Based on my own experience, I would advise anyone who likes systematic reviews to consider the program. It is a great opportunity to meet passionate researchers and work in an international environment. I got new perspectives on Cochrane methodology but also experiences that I think are important on a personal level.

 

 

Monday, June 20, 2022

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

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

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

Name: Agata Stróżyk
Location: Warsaw, Poland
CIM location: Lund, Cochrane Sweden

How did you first learn about Cochrane?
I first got a chance to better know what systematic reviews are and what the role of Cochrane is when I was participating in the Evidence-Based Medicine faculty at my university. Systematic reviews are critical in summarizing clinical evidence and Cochrane is the most methodologically rigorous at doing it! In Poland, we call the Cochrane Handbook our Bible for systematic reviews.

What was your experience with your virtual Cochrane International Mobility?
To be a part of a Cochrane systematic review was definitely on my to-do list. I was looking for any opportunity to be involved in Cochrane for about two years. I was a supporter at Cochrane TaskExchange and Cochrane Crowd. Finally, I contacted Matteo at Cochrane Sweden, who involved me in a systematic review that was already ongoing. Thus, I didn’t have to go through all process, but from the beginning of my traineeship, I had to do specific tasks. Matteo and Giovanni Cagnotto (also based at Lund University) were my supervisors and are very friendly, kind, patient, and supportive at each step, but also very motivating and fast-working – that was a great experience!

What are you doing now in relation to your Cochrane International Mobility experience?
At the moment, we hope to complete our systematic review, “Tumor necrosis factor (TNF) inhibitors for the treatment of psoriatic arthritis”, in a couple of weeks. For sure, I will use what I’ve learned to do methodologically better systematic reviews in the future. Moreover, I will still look for other opportunities to be a part of the Cochrane community, and maybe one day to prepare a new Cochrane systematic review within my area of expertise.

Do you have any words of advice to anyone considering a Cochrane International Mobility experience?
If you are interested in systematic reviews, I think it is a highly desirable step to participate in any kind of traineeship supervised by Cochrane. For any medical practitioners and researchers who would like to better understand the critical appraisal of evidence and its translation into practice, I think it’s a great option too. My personal advice: do not give up, if you do not get any response for the first time! Be persistent in chasing your dreams

 

Monday, June 13, 2022

New Review published: Digital technologies to help people with asthma take their medication as prescribed

Asthma is one of the most common long-term conditions worldwide. There are effective medicines available to treat symptoms, such as inhalers containing steroids. However, for best effect, maintenance medication need to be taken as prescribed. Many people do not take their medication, due to busy schedules and the belief that medication is only needed short-term. This is known as 'non-adherence', which can lead to more symptoms and attacks. Non-adherence is a major health problem; achieving adherence is very important to prevent attacks and reduce the risk of death. In healthcare there is increasing use of digital interventions such as mobile phones, text messages, and 'smart' inhalers that can feed back information about medication-taking. However, there is limited evidence on whether these technologies work to improve asthma medication-taking or improve symptoms.

This review aimed to find out whether digital technologies really work to improve asthma medication-taking, and whether this improved adherence leads to improvements in asthma symptoms and other benefits.

Study characteristics

We found 40 studies including more than 15,000 adults and children with asthma. Studies ranged from about 2 weeks to 24 months' duration, so we cannot say whether these methods are effective in the long term (a long period of years). We searched multiple information sources to identify relevant studies. This review is current as of June 2020. Looking at the data, we aimed to find out whether digital technologies helped people with asthma to take their medication as prescribed, and whether people who used the technology had better asthma control, and fewer asthma attacks, than those who did not use the technology.

Key results

People with asthma who were given the digital technology to support asthma medication-taking were better at taking their medication as prescribed compared to people who did not get the technology; 15% more people (likely to be somewhere between 8% and 22%) took their medication as prescribed when they received the digital technology, compared to those who did not (who took their medication on average 45% of the amount prescribed).

Importantly, people who got the digital technology had much better asthma control and half the risk of asthma attacks (likely somewhere between 32% and 91%), which has direct benefits for reducing the risk of asthma-related deaths. We saw improvements in quality of life and lung function, but the effect on lung function was small and may be of limited clinical relevance.

No improvements were seen in unscheduled healthcare visits. There was not enough information to tell us about the effect of digital technologies on time off work or school or the cost-benefits, nor whether there are any harms. Technologies were generally acceptable to patients. Certain types of technologies such as 'smart' inhalers and text messages seemed to be better for improving medication-taking than other technology types, although the small number of studies means we cannot be certain that these technologies definitely work better than others.

Quality of the information

There is some uncertainty about our results because the studies were quite different from each other. These differences mean that we cannot be completely sure what the real benefit is, as the benefits may be due to other factors not directly related to the technology - for example, being involved in a study can improve medication-taking. Sometimes the studies did not give us enough information for us to include them with the other studies to work out their effectiveness. We had concerns about a quarter of the studies where people did not finish the study, and we were uncertain whether studies reported everything they measured.

Practising GPs and authors on this Cochrane review Anna De Simoni and Chris Griffiths discuss using apps and digital tools with patients with asthma, they explain,

"The evidence in this review gives us more confidence to discuss their use. From this review we know electronic adherence monitors and text messages can help patients make more informed choices."

Key message

The studies we found suggest that digital technologies may help people with asthma take their medication better, improve their asthma control, and potentially halve their risk of asthma attacks, compared with people who did not get the technology. Certain types of digital technologies, such as text-message interventions, may work better than others. However, we have some uncertainties about the quality of the information reported in some studies, and the small number of studies for the different technology types, which means we cannot be 100% certain of their benefits.

Author Amy Chan explains,

 “Digital technologies that aim to improve medication taking can increase people taking their medication in way it has been prescribed by 15%, and improve asthma control and quality of life. Technologies that use text messages or electronic adherence monitors appear to be particularly effective for improving people taking their medication as prescribed.”

• Read the full review
• Visit the Cochrane Airways website

Monday, June 13, 2022

Tuesday, June 7, 2022

Monday, June 6, 2022

2022 marks the 5 year anniversary of  Cochrane Sweden. The center was established on the 17th of May 2017, in the city of Lund. For this milestone, Cochrane Sweden shares some of their many highlights. 

Over the past five years, Cochrane Sweden has been busy promoting evidence-based decision-making in healthcare in Sweden. Some accomplishments have been providing learning tools on how to conduct, edit and read systematic reviews. Cochrane Sweden launched Cochrane Interactive Learning as part of the curriculum for medical students at Lund University to support training in evidence-based health care. Cochrane Sweden is also the first Cochrane group to get unlimited access to Cochrane Interactive Learning. This has led to Sweden having the highest number of users per inhabitant in the world. Moreover, the strategic and fruitful collaboration with Lund University has provided unlimited access to Covidence and, in the coming days, to RevMan Web.

Each year Cochrane Sweden also provides many workshops, courses, and lectures about Cochrane, systematic reviews, evidence-based medicine, and more specialized topics, such as reviews of non-randomized studies, diagnostic test accuracy reviews and complex meta-analyses. We have trained hundreds of PhD students in the Cochrane methodology, and some of them have become Cochrane authors. Eleven master medical students have prepared their master theses at our centre. In 2017, Cochrane Sweden launched the Cochrane International Mobility program. Since then, more than 20 people have participated in this international exchange program to learn more about evidence-based medicine through collaborations between Cochrane Sweden and other Cochrane centers. You can read some examples of the researchers experience with the program here. We are much grateful to all members of our Advisory Board, which includes Swedish health professionals and Cochrane staff from six different groups, for their generous and qualified guidance.

For the past five years, Cochrane Sweden has been busy producing new research. So far, researchers affiliated to our center have completed 22 new or updated Cochrane Reviews, published 25 new Cochrane protocols and 38 other journal articles and reports. This has led to us often being mentioned in international and Swedish media. Currently, we also have 19 protocols and reviews in preparation. Several of these reviews have been commissioned by national and international stakeholders, including the World Health Organization.

 Cochrane Sweden has also collaborated with other centers through the Scandinavian GRADE Network. In 2022, we led the establishment of the network together with Cochrane Denmark, Cochrane Norway, SBU, the Danish Health Authority and the Norwegian Institute of Public Health.  

Our team has also grown up! In 2020, Martin joined as project coordinator, and indeed is coordinating lots of projects, from training to research and dissemination; Katarina is brilliantly delivering administrative support to our activities and contributing to develop new projects; in 2022, also Lea became part of the staff: she contributes to daily operations and ongoing research, such as the Swedish trial transparency report.

We have also produced a lot of content on social media. You can follow us on Twitter, LinkedIn, and Instagram, or register to our monthly newsletter. 

Visit the Cochrane Sweden website here, or drop-in at our office!

Vi ses!

Lea, Martin, Katarina, and Matteo

Tuesday, May 31, 2022

Candidates with experience in accounting and financial management are encouraged to apply

Cochrane is a diverse, global organization committed to informing healthcare decisions with the best available evidence from research. Organizationally, we are an international network of autonomously funded groups and a registered charity in the United Kingdom. Members of the Governing Board come from around the world and provide strategic leadership for the whole organization, as well as acting as Trustees of the UK charity.
 
Governing Board members work as a team, with complementary skills and backgrounds. They are a mix of elected members - who must be Cochrane Members - and appointed members, who bring an external perspective to the Board. Appointed members can be anyone with the relevant skills and experience and will not normally be Cochrane Members.

The Treasurer is a member of the Governing Board who supports their fellow Trustees to fulfil their obligation to provide financial oversight for the organization. Our current Treasurer, Karen Kelly, will step down from her position at the end of August 2023. To ensure a smooth handover and to increase the number of Board members with financial expertise, we are looking to appoint a new Board member who can act as Deputy Treasurer until August 2023, taking over as Treasurer from September 2023.

This is an exciting opportunity to join the board of an internationally renowned healthcare organization as we embark on a program of substantial change in how we are organized as a global collaboration, and seek to complete our transition to become a fully Open Access source of health evidence.

Appointed members serve an initial three-year term and may be reappointed. Board membership is a voluntary, unpaid role, although expenses will be paid.
 
The deadline for applications is 15 July 2022. To find out how to stand for appointment, please visit elections.cochrane.org.

 

Tuesday, May 31, 2022

Candidates with experience in digital product development, business development, or publishing are encouraged to apply

Cochrane is a diverse, global organization committed to informing healthcare decisions with the best available evidence from research. Organizationally, we are an international network of autonomously funded groups and a registered charity in the United Kingdom. Members of the Governing Board come from around the world and provide strategic leadership for the whole organization, as well as acting as Trustees of the UK charity.
 
Governing Board members work as a team, with complementary skills and backgrounds. They are a mix of elected members - who must be Cochrane Members - and appointed members, who bring an external perspective to the Board. Appointed members can be anyone with the relevant skills and experience and will not normally be Cochrane Members.
 
To replace current Board members retiring this year, we’re looking for two new appointed members with experience and expertise in one or more of the following areas:

• Digital product development
• Fundraising and business development
• Publishing and Open Access

The Board is running a separate appointments process for a new Treasurer. If you have expertise in accounting or financial management, particularly in a UK context, you should consider applying for the role of Treasurer instead. More information is available here.

This is an exciting opportunity to join the board of an internationally renowned healthcare organization as we embark on a program of substantial change in how we are organized as a global collaboration, and seek to complete our transition to become a fully Open Access source of health evidence.

Appointed members serve an initial three-year term and may be reappointed. Board membership is a voluntary, unpaid role, although expenses will be paid.
 
The deadline for applications is 15 July 2022. To find out how to stand for appointment, please visit elections.cochrane.org.

 

Tuesday, May 31, 2022

Thursday, May 26, 2022

Pay-for-performance (P4P) is an approach whereby individuals, teams or facilities within the health system are given money or other rewards for meeting service‐related targets, carrying out specific tasks or for meeting specific quality or health outcome thresholds. P4P has been one of the most ideologically charged topics in recent years in global health. It has attracted considerable investment, promotion, innovation, and assessment, but the issue of its effectiveness, efficiency and long‐term effects remains controversial.

A newly published Cochrane Library Editorial explores the challenges encountered by those who have conducted P4P systematic reviews and offers suggestions for future reviews and research on P4P. Karin Diaconu, lead author from Queen Margaret University in Edinburgh, says:

“This editorial offers an overview of 4 challenges we met with when evaluating 171 studies on pay-for-performance for systematic reviews. It also provides our reflections on the priorities for future evidence syntheses. We hope this editorial will help guide future studies and evidence synthesis projects about P4P.” 

• Read the Cochrane Library Editorial ‘Appraising pay‐for‐performance in healthcare in low‐ and middle‐income countries through systematic reviews: reflections from two teams’
• Read the Cochrane Review ‘Paying for performance to improve the delivery of health interventions in low‐ and middle‐income countries’
•        Listen podcast about review

Thursday, May 26, 2022

Wednesday, May 11, 2022

Now is the time to ‘up our game’ in using evidence to address health challenges

The COVID-19 pandemic created a once-in-a-generation focus on evidence. We now have the opportunity to systematize the aspects of evidence use that are going well and to address the many gaps.

Alongside the 75th World Health Assembly, Cochrane and the Global Commission on Evidence to Address Societal Challenges co-hosted a virtual side event which brought together a global panel to discuss some of these issues.

Speakers:

• Dr Soumya Swaminathan, Chief Scientist, WHO
• Fitsum Assefa Adela, Ministry of Planning and Development, Ethiopia
• Steven J. Hoffman, member of Canada's WHA delegation; Scientific Director, CIHR Institute of Population & Public Health
• Dr Maria Endang Sumiwi, Director General of Public Health at the Ministry of Health, Indonesia
• John Lavis, Co-Lead, Evidence Commission
• Dr John Grove, Director of Quality Assurance for Norms and Standards, WHO

Co-chairs:

• Judith Brodie, Interim CEO, Cochrane
• Sylvia de Haan, Head of Advocacy, Communications and Partnerships, Cochrane

About the session

During the roundtable, leaders from WHO Member States who use evidence to guide national decision-making were encouraged to reflect on their work – and share what they need from evidence producers, evidence intermediaries, and multilateral organizations. Cochrane, the WHO Evidence-informed Policy Network and the Evidence Commission then discussed their shared vision and recommendations.

The session was a dialogue between both the demand and supply side of evidence – highlighting the key priorities for the evidence-informed future we want and need, and the conditions needed to get us there.

 

Related links:

• Cochrane Convenes report
• Evidence Commission report
• WHO EVIPNet 

Friday, May 27, 2022

Tuesday, May 10, 2022

'Interventions to reduce the risk of coronavirus SARS‐CoV‐2 (severe acute respiratory syndrome coronavirus‐2) infection among workers outside healthcare settings'

What is the aim of this review?

Coronavirus (COVID‐19) is a respiratory infectious disease that has spread globally. People infected with SARS‐CoV‐2 (severe acute respiratory syndrome coronavirus‐2) can develop critical illnesses and may die, particularly older people, and those with underlying medical problems. Different interventions that attempt to prevent or reduce workers' exposure to SARS‐CoV‐2 in the workplace have been implemented during the pandemic. This Cochrane Review evaluated the effects of these interventions on the COVID‐19 infection‐rate, absenteeism, COVID‐19‐related mortality, and adverse events.  

What was studied in this review?

The authors searched for studies that examined interventions according to the following four categories: 1) elimination (for example self‐isolation strategies); 2) engineering controls (for example barriers to separate or distance co‐workers, and workers from members of the public); 3) administrative controls (for example working from home); 4) personal protective equipment (for example use of face masks or other types of face covering). We included studies of any worker outside the healthcare setting. We searched for studies without language or time restrictions. 

What are the main findings of this review?

The author team screened more than 13 thousand reports, and included one study, conducted in 162 secondary and post‐secondary schools in England, from March to June 2021. The study enrolled more than 24 thousand workers. In the 86 schools in the control group (standard isolation), staff who were considered COVID‐19 contacts through contact tracing were required to self‐isolate at home for 10 days. In the 76 schools in the intervention group (test‐based attendance), staff who were considered COVID‐19 contacts through contact tracing were not required to isolate. Instead, they took a daily rapid test (lateral flow antigen test) for seven days. If the rapid test was negative, the staff member could go to work. If the rapid test was positive, the staff member would self‐isolate. The researchers wanted to know if there was a difference in COVID‐related absence between the two methods. 

The author team are uncertain whether a strategy of test‐based attendance changes COVID‐19 infection rates (any infection; symptomatic infection) compared with routine isolation after contact with a person with COVID‐19. COVID‐related absence may be lower or similar in the test‐based attendance group. 

However, they were uncertain about these findings, because the number of infections was very low among the participants. Mortality, adverse events, quality of life, and hospitalisation were not measured. Seventy‐one per cent of the test‐based attendance group followed the strategy; the researchers did not report on compliance for the standard isolation group. 

The team identified one ongoing study that also addressed the effects of screening in schools.

Another ongoing study is evaluating the effects of using a face shield to prevent COVID‐19 transmission. 

The authors did not find any studies that studied engineering or administrative controls.

Matteo Bruschettini, Director of Cochrane Sweden, who led the review explains, 

“Millions of scientific papers are published every year, and during the pandemic there were many about covid-19. It is not an easy task to keep up to date with the results of all these. Systematic reviews are one way of weighing up all the studies carried out in a specific field and providing an overview of the results of these studies.  This review investigating how workplace interventions reduced the spread of covid-19 assessed 13, 000 scientific articles published on the subject, however only one study could be included in the review. 

Almost none of the studies had the study design required to answer the question of whether the effects of the intervention reduced the risk of SARS-CoV-2 infection in non-healthcare workplaces. This surprised us. These systematic reviews are important because they can provide answers to questions that are of extreme concern to millions of people in workplaces around the world. 

We were able to identify two studies that had not been completed by September 2021 that may be included in the future. One assesses the benefit of face shields in preventing covid infection and the other looks at covid-19 screening in schools.”

How up‐to‐date is this review?

The author team searched for studies that were available up to 14 September 2021.

• Read the full review
• Read the Lund University press release (in Swedish)

 

Monday, May 9, 2022

Monday, May 9, 2022

Specifications: Full Time (Permanent role)
Salary: £85,000 per annum
Location: UK, homebased and remote-working (attendance at meetings will be expected to pursue development and build relations)
Application Closing Date:  Monday 6th June 2022, 9am GMT. The recruitment agency will be longlisting applications as soon as they receive them, so please apply early to register your interest. 

Cochrane aims to put evidence at the heart of health decision-making globally. They collaborate to produce trusted synthesized evidence, make it accessible to all, and advocate for its use. Cochrane is seeking a Director of Development to work with their global community to grow fundraising income and ensure Cochrane has a sustainable and successful future.

Cochrane is a charity and 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. They do this by synthesising research findings to produce the best available evidence on what works. Their work has been recognised as the international gold standard for high quality, trusted information.

As a member of the Executive Leadership Team, this new role will lead the Development Directorate (which includes fundraising, advocacy, communications, partnerships, member and supporter engagement) and will establish a fundraising operation that works collaboratively to deliver significant global income growth. The Director of Development will play a key part in the transformation of the organisation as part of the 2021-2023 Strategy to ensure that Cochrane maintains its relevance and pre-eminence into the future.

Cochrane is seeking an ambitious individual who relishes a challenge, loves collaborative working, delivers results and has extensive experience of successfully delivering strategy. The ideal candidates will possess an understanding and experience of international fundraising, strong relationship management skills, and experience of working at director-level. Finally, you will be enterprising and a strategic thinker with the ability to seek and find creative solutions and foster innovation in your teams.

Cochrane welcomes applications from a wide range of perspectives, experiences, locations and backgrounds; diversity, equity and inclusion are key to their values.

• Obtain the candidate pack and further information on how to apply
• Read our Recruitment Privacy Statement 

Friday, May 6, 2022 Category: Jobs

Specifications: Full Time 6 month Fixed Term contract (potential opportunity to extend)
Salary:  circa £40,000 per annum
Location: UK, Remote
Application Closing Date: 18 May 2022 (midnight GMT)

The Evidence Production and Methods Directorate in Cochrane is made up of three departments that are responsible for the efficient and timely production of high-quality Cochrane Reviews addressing research questions that are most important to decision makers.

As Quality Assurance Editor within Cochrane’s Editorial Department, you will assess whether protocols, reviews and updates submitted to Cochrane’s Central Editorial Service have met Cochrane’s methodological standards. You will recommend editorial decisions based on the quality of the methods in the articles submitted, provide feedback to authors on their articles, and support members of the Central Editorial Service with methods queries. 

Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We do this by identifying, appraising and synthesizing individual research findings to produce the best available evidence on what can work, what might harm and where more research is needed.

• For further information on the role and how to apply, please click here. 
• The deadline to receive your application is by 18 May 2022. 
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
• Note that we will assess applications as they are received, and therefore may fill the post before the deadline.
• Read our Recruitment Privacy Statement 

Wednesday, May 4, 2022 Category: Jobs

Dear Friends and Colleagues

Due to the continued global impact of COVID-19 (coronavirus) with ongoing reduced/restricted travel from many regions, and the advent of geo-political instability and risks in the European region, we have taken the decision to postpone the Global Evidence Summit (GES 2), due to be hosted in Prague between 2 – 6 October 2023.

The Global Organising 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 postpone the Summit until 9 – 13 September 2024. 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.

However, we are committed to working together, along with additional organizations, to present the third Annual World EBHC Day on 20 October, 2022. This is a global initiative that raises awareness of the need for better evidence to inform healthcare policy, practice and decision making to improve health outcomes globally.

This second postponement of the second Global Evidence Summit is disappointing news for all of us and we would like to thank the vast number of people, including our local hosts, who have been working hard on preparations over the past year. 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 September 2024 in Prague it will be everything we anticipated: a world-class scientific event and a memorable gathering of the evidence-based healthcare community. 

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 2024. 

Recent developments have shown the world can be volatile and unpredictable, requiring us to remain vigilant and responsive – collaborations such as this are even more important.   We hope that you all remain safe and well during these extraordinary times. 

Miloslav Klugar
Director, CEBHC-KT (Czech Cochrane, JBI and GRADE centres), Chair of the GES Scientific Committee

Judith Brodie
Interim CEO, Cochrane

Zoe Jordan
Executive Director, JBI

Elaine Harrow
CEO, Guidelines International Network

Vivian Welch,
Interim CEO, The Campbell Collaboration

Wednesday, May 4, 2022

A potential game-changer in the tuberculosis epidemic was how the tuberculosis community viewed rapid molecular tests for tuberculosis and tuberculosis drug resistance. This was 12 years ago, with the launch of Xpert MTB/RIF, which gives results in less than two hours, simultaneously diagnosing tuberculosis and testing if the bacteria have rifampicin resistance, a type of drug-resistant tuberculosis. Multidrug-resistant tuberculosis is caused by resistance to at least both rifampicin and isoniazid, the two most effective first-line drugs used to treat tuberculosis. 

Yet, diagnostic tests only have an impact on health if they are put to use in a correct and timely manner. To ensure diagnostics are accessible and utilized, we need to understand the views of recipients and providers who have used these tests, and a new qualitative evidence synthesis review published by the Cochrane Infectious Diseases Group (CIDG) pulls together all relevant research to date on Xpert MTB/RIF and similar tests. The authors also wanted to understand the implications of the review findings on effective implementation and health equity.

Rapid molecular tests have been shown to be accurate in diagnosing tuberculosis and rifampicin resistance and are recommended by the World Health Organization as the initial test in people with presumptive tuberculosis, replacing sputum microscopy, a test from the 19th century. These tests have many benefits, including the fact that they do not require well-equipped laboratories and skilled personnel, and can be carried out in community health settings, nearer to where people live. This is particularly relevant in low- and middle-income countries, settings with a high burden of tuberculosis.

Examining the evidence from 32 included studies, the review author team identified aspects of these tests that users valued  most and challenges to realizing those values.  People with tuberculosis valued an accurate diagnosis (knowing what is wrong with me), avoiding delays, and keeping diagnostic-associated cost low. Similarly, healthcare providers valued test accuracy and confidence in results (which helps in starting treatment), rapid results, and keeping cost to people seeking a diagnosis low. In addition, providers valued diversity of sample types (for example, gastric aspirate specimens and stool in children) and ability to detect drug resistance early. Laboratory professionals appreciated the improved ease of use compared to microscopy and increased staff satisfaction.

Reported challenges included reluctance to test for tuberculosis owing to stigma or cost concerns; health system inefficiencies such as poor quality of specimens, difficulty in transporting specimens, lack of sufficient staff or equipment, increased workload for providers, inefficiencies in integrating the test into clinic routines and clinicians relying too much on the test result at expense of their own experience with diagnosing tuberculosis; as well as implementation processes hampered by insufficient  data about real-life situations, lack of inclusion of all relevant stakeholders (local decision-makers, providers or people seeking a diagnosis), and conflicts of interest between donors and people implementing the tests.

Nora Engel, lead author of the review, explains: 

“The findings reveal a fundamental paradox between supporting technological innovations but not in parallel investing in health system infrastructure strengthening. The view that these low-complexity diagnostics are a solution to overcome deficiencies in laboratory infrastructure and lack of skilled professional is misleading. Implementation of new diagnostic technologies, like those considered in this review, will need to tackle the challenges identified in this review including weak infrastructure and systems, and insufficient data on ground level realities prior and during implementation, as well as problems of conflicts of interest in order to ensure quality care and equitable use of resources.”

The review authors called for future research to examine the implications of repurposing diagnostic infrastructure and equipment for COVID-19 and the issue of competition for diagnostic resources more generally.

Engel N, Ochodo EA, Karanja PW, Schmidt BM, Janssen R, Steingart KR, et al. Rapid molecular tests for tuberculosis and tuberculosis drug resistance: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2022, Issue 4. Art. No.: CD014877. DOI: 10.1002/14651858.CD014877.pub2

• Read the plain language summary
• Read the full Cochrane Review
• Visit the Cochrane Infectious Disease website

This news article was first published on the LSTM website.

Monday, May 2, 2022

Cochrane is delighted to announce the availability for the first time of RevMan Web, its popular, web-based systematic-review production software, to the wider community beyond Cochrane – to support evidence synthesis development and evidence-based medicine education. Cochrane expects interest in use of the tool from those in guideline and Health Technology Assessment organisations, universities and medical schools, and many other research sectors.

RevMan Web facilitates the creation of meta-analyses, forest plots, risk-of-bias tables, and other systematic review elements. It is acknowledged to be easy-to-use – and is also widely used in learning or training about systematic review production.

Cochrane is making RevMan Web available for use by institutions or individuals for their own systematic review development work. The product is presented on a Software-as-a-Service basis: Cochrane offers a hosted service, comprising the software and cloud storage of all review data uploaded. 

Charlotte Pestridge, Cochrane’s Director of Publishing and Technology, says this is a hugely exciting opportunity:

“Making RevMan Web more widely available is an important element in Cochrane’s contribution to healthcare research and our mission to deliver evidence-informed policy and practice through the production of systematic reviews. It is important for Cochrane to be able to support the production of high-quality reviews using Cochrane standards and methodologies. Many review-producing organisations, including key Cochrane stakeholders, already use RevMan.”

 RevMan Web is now available by subscription to government and commercial organizations. Availability for academic institutions and individual subscribers is expected to come on stream before the end of 2022. Free access will be available in Reseach4Life Hinari low and middle-income countries.

To find out more:

• https://links.cochrane.org/revman
• RMWsubscriptions@cochrane.org
• View and Download flyer

Wednesday, June 1, 2022