Sprains, strains and bruises: Oral non-steroidal anti-inflammatory drugs compared with other oral pain killers
Sprains, strains, and bruises are common injuries, and people with these injuries often require pain relief, given as a tablet or capsule that is swallowed (oral). Many types of oral painkillers are available to treat such injuries. The authors wanted to know whether there were any differences in people’s pain, swelling, function, or unwanted side effects when sprains, strains, and bruises were treated with oral non-steroidal anti-inflammatory drugs (NSAIDs, e.g. ibuprofen) compared with paracetamol, opioids (e.g. codeine), complementary or alternative medicines, or combinations of these.
What did the authors do?
They searched medical databases up to January 2020 for studies that compared NSAIDs with other painkillers in people with sprains, strains, and bruises. Study participants could be any age. They assessed the included studies to judge the reliability (certainty) of the evidence. They categorised the evidence as being of high, moderate, low, or very low certainty. High certainty means they are confident in the evidence, moderate certainty means they are fairly confident, low or very low certainty means that they are unsure or very unsure of the reliability of the evidence.
Results of searches and description of studies
The review includes 20 studies, with 3305 participants. Seven studies included people with ankle sprain only. Three studies included children only. Most of the participants of the other studies were young adults, and there were slightly more men than women. Few participants were aged over 65 years. Eleven studies compared NSAIDs with paracetamol, six studies compared NSAIDs with opioids, and four studies compared NSAIDs with paracetamol combined with an opioid. Studies reported outcomes at times varying from one hour after taking the medication, up to 10 to 14 days.
There is no difference between NSAIDs and paracetamol in pain after one to two hours, or after two to three days (high-certainty evidence), and there may be no difference after a week or more (low-certainty evidence). There is low-certainty evidence that NSAIDs may make little difference to swelling after a week or more. The authors are uncertain whether NSAIDs make a difference to return to function after a week or more (very low-certainty evidence). There is low-certainly evidence that NSAIDs may slightly increase unwanted side effects related to the gut.
There is probably no difference between NSAIDs and opioids in pain at one hour (moderate-certainly evidence), and there may be no difference four or seven days after taking medication (low-certainty evidence). They are uncertain whether NSAIDs make a difference to swelling after 10 days (very low-certainty evidence). There is low-certainty evidence that NSAIDs may increase return to function in 7 to 10 days. There is moderate-certainty evidence that NSAIDs probably result in fewer unwanted side effects, such as nausea and dizziness, compared with opioids.
The evidence suggests that there is little or no difference between NSAIDs and paracetamol combined with opioids in pain, swelling, return to function, or unwanted side effects. However, the evidence was very low certainty, so the authors are uncertain of these results.
No studies reported the risk of re-injury after treatment. The authors found no studies comparing NSAIDs with complementary or alternative medicines.
The body of evidence to date has found no difference between NSAIDs and other pain killers for pain relief for strains, sprains, and bruises in younger people. However, the authors need more, and better evidence on return to function and unwanted side effects in all age groups, particularly in older people.
Peter Jones Associate Professor of Emergency Medicine at the University of Auckland, Faculty of Medical and Health Sciences and Director of Emergency Medicine Research Adult Emergency Department, Auckland City Hospital summarized:
“Sprains, strains and bruises are common injuries. Often people are unsure which medication to take, anti-inflammatory drugs, paracetamol or an opioid such as codeine or to treat with a complimentary therapy or alternative medicine. We found evidence that there was no difference between the common pain medications in the amount of pain relief achieved. However, we need more, and better evidence on unwanted effects on the gut in all age groups but particularly in older people.”
This is an update of a Cochrane review published in 2015.
Thursday, August 13, 2020
For 12 hours the host Adam Smith (@BetterResearch) will be chatting with 55 researchers from all fields of dementia research, using video chat – live streamed using Zoom and YouTube. They will discus their research, the latest hot topics in their field, and how they are working to beat the disease and improve the lives of people affected. This event is open to everyone interested in finding out more about the latest research taking place on dementia and information will be accessible to researchers, healthcare professionals, and family and carers. It is a free event with donations being accepted to Alzheimer’s Research UK (@AlzResearchUK).
Dr Terry Quinn (@DrTerryQuinn), Coordinating Editor of Cochrane Dementia and Cogitative Improvement, will be sharing evidence from Cochrane systematic reviews and meta-analysis in dementia research and will be explaining how the Cochrane group is working to raise standards in research design and reporting. Dr Quinn will be speaking at the 19:30 - 20:00 GMT timeslot.
Cochrane is in the final year of its multi-year strategic plan, Strategy to 2020.
Strategy to 2020 has set in motion transformational change in the way Cochrane works at all levels of the organization with the aim of giving us the best chance to achieve our mission.
Watch the video below to see how Strategy to 2020 was developed and change it has ushered in for Cochrane:
We are now developing a new strategy for the period 2021 to 2025, and we want to hear from you! Let’s collaborate to define Cochrane’s strategy for the next five years.Wednesday, August 12, 2020
Cochrane is in the final year of its seven-year strategic plan, Strategy to 2020.
Strategy to 2020 set in motion transformational change in the way Cochrane works at all levels of the organization with the aim of giving us the best chance of achieving our mission. Watch the first in a new video series looking back over the last seven years and forward to the challenges and opportunities that remain for Cochrane on the Community website.
We intend that this new strategy, which will shape the organization’s priorities and investment approach for the next five years, will help us go further in realizing our vision of a world of better health for all people.
Many of the initiatives started during Strategy to 2020 are still being implemented and most of the strategic aims remain relevant. For this reason, the Governing Board and Senior Management Team are proposing the new strategic framework takes forward the structure of the Strategy to 2020, but with some important changes.
#Letscollaboratecochrane! The Governing Board and Senior Management Team want to hear from all Cochrane Groups, members and supporters about whether the proposed new vision, mission, goals and objectives represent your priorities for Cochrane over the coming years.
The aim is to launch the final version at the virtual Annual General Meeting in November 2020, with activities to deliver the outcomes set out in the framework beginning from 2021. Your input will be collated, reviewed and used to make changes to the version now open for consultation. As a collaborative membership organization, it is critical that the new strategic framework is sensitive to the experiences, insights and ambitions of Cochrane’s members and key stakeholders.
Our next strategy: Let’s collaborateWednesday, August 12, 2020
In a new systematic review, an author team from the Cochrane Infectious Diseases Group explored the evidence regarding managing histoplasmosis in people with HIV. Their review informed the PAHO/WHO guideline development process. The review authors worked with the guideline development group to formulate key questions, including which antifungal drug to start, how long to continue, and when to start antiretroviral medication. They also looked at tuberculosis therapy when people were infected with tuberculosis, HIV, and histoplasmosis.
Histoplasmosis is an infection caused by inhaling a fungus called Histoplasma. The most severe form of histoplasmosis is called progressive disseminated histoplasmosis, in which the infection spreads from the lungs to other organs. It is life‐threatening for people with advanced HIV. Before this Cochrane Review and the updated PAHO/WHO guidelines, the guidelines for management of disseminated in histoplasmosis were designed for high-resource settings, and were out of date, given that antiretroviral therapy (ART) is widely available and treatment paradigms have changed.
LSTM’s Clinical Research Associate Dr Marylou Murray and Infectious Diseases Consultant and Research Fellow Dr Paul Hine assessed the available evidence and included 17 studies in the Cochrane Review. They found that liposomal amphotericin B may improve clinical success compared to deoxycholate amphotericin B when starting treatment, and that liposomal amphotericin B results in less kidney damage compared to deoxycholate amphotericin B when starting treatment.
Based on the review evidence, it is unclear how long people should stay on treatment after they have successfully completed the starting stage. It is also unclear at what time during treatment of the fungal infection it is best to start treatment to fight the HIV virus. However, recognising the uncertainty is a key step to help prioritise important research questions going forward.
Dr Hine said: “Cochrane Infectious Diseases Group have forged new partnerships in this neglected field, helping with a big step forward in agreeing international guidelines and policy into the future”.
The internationally available WHO/PAHO guidelines will help direct treatment and improve outcomes. In addition, the guidelines and the consensus reached may help improve access to antifungal drugs for people living in low- and middle-income countries who suffer from HIV and histoplasmosis.
- Murray M, Hine P. Treating progressive disseminated histoplasmosis in people living with HIV. Cochrane Database of Systematic Reviews 2020, Issue 4. Art. No.: CD013594. DOI: 10.1002/14651858.CD013594.
- PAHO/WHO. Guidelines for Diagnosing and Managing Disseminated Histoplasmosis among People Living with HIV. www.paho.org/en/node/71472
- Learn more about Cochrane Infectious Diseases Group
Tuesday, August 11, 2020
- Contract: Fixed-term, 12 months
- Hours: Full time, 37.5 per week (part time considered)
- Salary: £31,365 - £37,890 per annum pro rata (dependent on experience)
- Position Closing: 20 August 2020
Cochrane Acute and Emergency Care Network is seeking a Network Support Fellow. 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.
This job is hosted by the Cochrane Pain, Palliative and Supportive Care Review Group (PaPaS CRG) at the Churchill Hospital, part of the Oxford University Hospitals NHS Foundation Trust. Flexible (home) working will be considered, with the expectation that the post holder will attend meetings in person when required. The post is funded by the National Institute for Health Research (NIHR) to work with the Network of Cochrane Review Groups (CRGs).
The Network Support Fellow will work in support of the general aims and objectives of the CRG Transformation Plan, but with a particular focus on ensuring that the Network is positioned to provide maximum support for the NHS. The Network Support Fellow will have an individual work plan aligned to the Network’s Strategic Plan which has the following objectives:
- supporting review production and capacity;
- evaluating Network scope and prioritisation of topics;
- fostering collaboration within the Network and with the wider Cochrane community;
- supporting knowledge translation to increase the impact of Cochrane Systematic Reviews;
- ensuring accountability and sustainability of the Network.
Please refer to the full job description and person specification for more details of the role.
Interventions for acute severe asthma attacks in children: an overview of Cochrane Reviews
Asthma is a common childhood illness that is caused by narrowing of the small air passages in the lungs. This narrowing is due to swelling and inflammation and to muscles around the air passages becoming tighter. An acute asthma attack results in shortness of breath, cough, wheeze, and chest tightness.
When children have an asthma attack, the standard treatment is to give steroids to reduce inflammation and swelling (usually given by mouth) and inhaled medications to relax the muscles in the air passages (called "bronchodilators"). In this review, that standard treatment is called "first-line" treatment. These medications are well understood to be the best treatments for use in the first instance.
Some children's asthma attacks do not improve with first-line treatment, and more treatment is necessary - usually at the emergency department or hospital; in this review, we call this 'second-line' treatment. However, the best second-line treatment for children who do not respond to first-line treatment is poorly understood. Many treatment options are available, and what is done for children varies from hospital to hospital.
The author team wanted to look at existing Cochrane Reviews of second-line treatments for children having asthma attacks. They aimed to be able to bring this information together in a useful way and to present the evidence that would help the practitioner make the best treatment decision for each child having an asthma attack when inhaled bronchodilators and oral steroids have not helped with symptoms.
The overview includes 13 Cochrane Systematic Reviews on various treatment options, including inhaled medication, intravenous medications, and other therapies. This overview provides the most up-to-date evidence from systematic reviews with meta-analyses of randomised controlled trials on acute severe asthma in children. This overview is current to December 2019.
For children with acute severe asthma requiring additional treatment, the authors found that:
- intravenous magnesium sulfate (a bronchodilator given through a vein) appears to reduce the length of time spent in hospital;
- no evidence suggests that any treatment reduced the risk of being admitted to intensive care;
- some treatments appeared to reduce the risk of hospital admission. These included adding a second type of inhaled bronchodilator treatment (anticholinergic medication such as ipratropium bromide) to standard inhaled treatment (beta-agonist such as salbutamol), giving intravenous magnesium sulfate, and breathing a mixture of helium and oxygen;
- serious adverse events may be reduced by inhaled magnesium sulfate;
- nausea and/or vomiting is more common with aminophylline (another bronchodilator medication given through a vein); and
- adding a second type of inhaled bronchodilator treatment (anticholinergic medication such as Ipratropium bromide) reduces the risk of nausea and tremor but not vomiting.
Why is this question important?
The global COVID-19 pandemic highlights the importance of accurate and timely contact tracing. Contact tracing tells people that they may have been near someone with - or showing symptoms of - an infectious disease, allowing them to self-isolate and helping to stop the spread of infection. Traditionally, contact tracing begins with notification that someone has an infectious disease. They are asked to recall their contacts, going back two to three days before symptom onset. This is time-consuming and may not always give a complete picture, so digital aids could help contact tracers.
Digital contact tracing uses technology to track and trace contacts. Individuals download an app onto their smartphones and record location and symptom information, or their devices might use location-finding technology, like Bluetooth or GPS (global positioning system). If the user is infected, the technology identifies close contacts and/or secondary infections (people to whom they passed the disease), and informs people whom they have been near. The technology identifies where the infection was passed on and its duration (the context).
However, problems may occur where access to technology is limited, in low-income settings or for elderly people, for example. Also, some people see it as an invasion of privacy and are suspicious of how their data will be used.
The authors wanted to know whether digital contact tracing, compared to manual contact tracing, is effective in reducing the spread of infection, as measured by secondary infections, identifying close contacts, tracing a complete set of contacts, and identifying the context of infection.
The authors found 12 relevant studies. Six assessed the effectiveness of digital contact tracing on specific groups (cohorts) of people: three during an outbreak (Ebola in Sierra Leone; tuberculosis in Botswana; and whooping cough (pertussis) in USA); and three replicated an outbreak in schools to assess systems for identifying close contacts of participants. The remaining six were modelling studies, which simulated digital contact tracing.
Digital contact tracing with self-isolation probably reduces the number of secondary infections, but not as much as manual contact tracing with self-isolation (2 modelling studies).
Digital contact tracing found more close contacts in two outbreaks than manual (2 studies in USA and Sierra Leone). Devices in non-outbreak settings can identify more close contacts than self-reported diaries or surveys.
An app may reduce the time to complete a set of close contacts (1 study). Digital systems were faster to use than paper systems for recording new contacts and monitoring known contacts, and possibly less prone to data loss.
Problems with system access (2 studies) included patchy network coverage, lack of data, technical problems and higher staff training needs. Contact tracers' personal expenses increased (1 study) due to travel and recharging phone batteries. Devices all appeared to protect diagnosed users from contacts, snoopers and authorities but one app's users were members of public health agencies. Studies recorded stolen hardware (second-hand mobile phones); reported that paper forms were "often lost", and that digital data were password protected (2 studies) and encrypted (1 study).
We found no evidence on contextual information and acceptability.
What this means
It is unlikely that digital technologies would be the sole method of contact tracing during an outbreak; they would probably be used alongside manual methods. Unfortunately, the technology is largely unproven in real-world outbreak settings and none of our included studies assessed digital plus manual contact tracing with digital contact tracing alone. Our included studies assessed different technologies and used different methods from each other, so we are uncertain about their evidence.
Governments that implement digital contact tracing should ensure that at-risk populations are not disadvantaged and take privacy concerns into account.
This review is up to date to May 2020.
Featured Review: Interventions available during pandemics for heavy menstrual bleeding: an overview of Cochrane reviews
Cochrane authors summarised the available evidence on the effectiveness and safety of treatments for heavy menstrual bleeding which can continue during pandemics.
Pandemics impact upon the ability to deliver specialist assessment and treatments. Examples of treatments that commonly continue during pandemics include non-steroidal anti-inflammatory drugs (NSAIDs), antifibrinolytics, combined hormonal contraceptives, and progestogen.
There is low-certainty evidence that NSAIDs (mefenamic acid) reduce heavy menstrual bleeding when compared with placebo.
There is moderate-certainty evidence that antifibrinolytics (tranexamic acid) and combined hormonal contraceptives reduce heavy menstrual bleeding when compared with placebo.
There is low-certainty evidence that antifibrinolytics (tranexamic acid) are more effective in reducing heavy menstrual bleeding when compared with NSAIDs and short-cycle progesterone
We were unable to draw conclusions about the effects of antifibrinolytics (tranexamic acid) when compared to long-cycle progesterone.
No conclusions can be made with regards to quality of life, women's satisfaction with treatment, or serious adverse events.
Dr James Duffy, Clinical Fellow, King’s Fertility, underscores the importance of the overview review, “During the COVID-19 pandemic it has become clear that the impact upon specialist assessment and treatment will continue. It is important health care professionals and women experiencing heavy menstrual bleeding have access to a Cochrane review which evaluates and summarises the evidence base for the treatments which can often continue during the pandemic.”
A decision aid has been developed to support shared decision making during virtual consultations. Women with heavy menstrual bleeding helped to develop the decision aid, which draws upon the evidence summarised within the Cochrane review.
Dr Duffy adds: "Developing a decision aid alongside the Cochrane overview presents a unique opportunity to bring together the best research evidence alongside a women’s preferences, circumstances, and values. We anticipate the decision aid will support shared decision making. It is important women experiencing heavy menstrual bleeding are able to understand the range of possible treatments available, their risks and benefits, and be afforded the opportunity to consider these decisions within their own context and circumstances."
Many healthcare workers are at the front line of the COVID-19 pandemic, delivering emergency and critical care, while others continue to deliver the broader services of the health system in hospitals, clinics, offices, communities, and homes. Working under difficult and stressful circumstances that are likely to continue for some time, exacerbates existing risk factors such as occupational stress and shift work. Supporting the wellbeing of healthcare workers will be crucial to sustaining our health systems during and beyond the current crisis.
This Special Collection brings together Cochrane evidence on interventions that may help support the wellbeing of the healthcare workforce and reducing occupational stress.
These reviews have been produced Cochrane Review Groups in three Networks: Cochrane Mental Health and Neuroscience; Cochrane Musculoskeletal, Oral, Skin and Sensory; and Cochrane Public Health and Health Systems. Some reviews in this collection have associated Cochrane Clinical Answers.
The Usher Institute at the University of Edinburgh is seeking a highly skilled and motivated epidemiologist/research fellow to work in the field of vascular disease, including both the diagnosis and treatment of peripheral vascular diseases and the development of vascular complications of type 2 diabetes. The primary role will be to undertake a series of high quality systematic reviews on the prevention, diagnosis and treatment of vascular diseases, including abdominal aortic aneurysm, venous thromboembolism and peripheral arterial disease, within the core programme of work which constitutes the CSO funded research project, Cochrane Vascular, one of 25 Cochrane review groups based in the UK. The main purpose of this work is to identify key areas of clinical importance to the management of peripheral vascular disease globally, and to produce and disseminate high quality evidence to guide clinical management, using state-of-the art systematic review methodology. They will also have a data management, quality control and supervisory role for a well-established epidemiological study (the Edinburgh Type 2 Diabetes Study), which aims to identify biomarkers and potential aetiological risk factors for vascular complications affecting people with type 2 diabetes.
Applicants must have (or expect to achieve) a PhD in epidemiology or related subject, with experience of the design, conduct and reporting of large-scale randomised controlled trials, prospective cohort studies and other epidemiological study types; execution of statistical analysis; adherence to data/research governance and best practice guidelines for use of health-related data; experience of handling large data-sets in a variety of databases. Applicants will also have excellent scientific writing skills, with a good publication track record (minimum three publications in peer-reviewed journals, with at least one paper reporting analysis of an epidemiological study and/or systematic review).
The post is available from 1 August 2020 or as soon as possible thereafter, part-time (20 hours per week) and available until 31 December 2022.
In medicine, rehabilitation is a multiprofessional process aimed at enhancing and restoring functional ability and quality of life to people with impairments or disabilities. In the context of the COVID-19 pandemic, rehabilitation focuses on the sequelae of the disease as well as on the impairment due to treatments applied. COVID-19 patients may develop a myriad of acute medical problems and their treatment often requires invasive procedures: all of which can cause mid- and long-term consequences requiring rehabilitation. Rehabilitation is applied throughout the continuum of care, starting in the acute, mostly in the post-acute and continuing in the chronic phase of a disease. As well, there has been a disruption of regular rehabilitation of people with disabilities and chronic diseases due to quarantine, social isolation, movement restriction, and other healthcare systems’ disruptions. Given the current COVID-19 situation, having the best available rehabilitation evidence is even more important to help reduce clinical uncertainty.
To update the rehabilitation community on the growing evidence for the role of rehabilitation in management of COVID-19 patients, Cochrane Rehabilitation launched the REH-COVER (Rehabilitation – Covid-19 Evidence-based Response) action.
The aim of this action is to focus on the timely collection, review, and dissemination of summarized and synthesized evidence relating to COVID-19 and rehabilitation. This will create an evidence-based answer repository to the newly-risen clinical questions and problems. The action was developed by an international multi-professional Steering Committee, whose role will continue to advise on all initiatives included in this action.
Cochrane Rehabilitation REH-COVER action currently includes four main initiatives:
- Rapid living Systematic Reviews on Rehabilitation and COVID-19 updates published monthly
- Interactive living evidence map on Rehabilitation and COVID-19
- Definition of the research topics on “Rehabilitation and COVID-19” in collaboration with the WHO rehabilitation programme
- Forthcoming Cochrane Library Special Collection: Coronavirus (COVID-19): rehabilitation of patients with functional consequences of acute illness and its treatments, will be published soon
Other initiatives under development include:
- Living Systematic Review on “current evidence on rehabilitation of patients with functional consequences of COVID-19 and its treatments”: results expected in July 2020
- Collaboration with COVID-END for the topics “rehabilitation” and “disability”: discussion started in June 2020
The number of people who do not have enough to eat in the world has been increasing since 2015. Most of these people live in low- and middle-income countries (LMICs), especially in Asia and Africa. Food insecurity is when people do not have physical, social and economic access to sufficient, safe, nutritious foods to be healthy. That is, they do not have enough money to buy food, or do not have anywhere to shop or cannot find food near to where they live. Food insecurity affects the health, social and economic situation of individuals and communities.
COVID-19 and food insecurity Food insecurity has increased as a result of measures implemented throughout the world to prevent the spread of COVID-19. ‘Lockdowns’ restrict people’s movement and their ability to work, leading to loss of income and livelihoods, particularly for people in the informal economy. This, in turn, limits people’s physical and economic access to food. Disruptions to food supply, from harvesting to transport to labour supply, negatively affect food prices and availability. School closures affect millions of children who access food through school meal schemes. The effects of lockdown are felt everywhere, but disproportionally affect poor and vulnerable people.
This Cochrane Review looked at the effect of community-level interventions on individuals, households and communities in LMICs to improve access to nutritious food. The main outcome was food security, measured by prevalence of undernourishment, proportion of household expenditure on food, and proportion of people and households who ate a diverse diet, that is, a variety of foods from different food groups. Other outcomes reflected nutritional status, such as how well children grew (stunting), low body weight (wasting) and cognitive function (thoughts and understanding).
The review authors found 59 studies that assessed different interventions, mainly in Africa and Latin America. Many studies assessed cash transfers, which are welfare programmes where money is provided to households. Of these, 21 studies evaluated unconditional cash transfers, where there are no conditions for receiving the money, and 14 studies assessed conditional cash transfers, where people had to meet specific conditions in order to receive the money. Seventeen studies looked at income generation interventions (for example, livestock management or self-help groups), four studies at food vouchers, four studies at providing food and nutrition subsidies, and two studies looked at social support interventions such as village savings and loans and community grant programmes.
Unconditional cash transfers improve food security but make little or no difference to cognitive function or development. They may increase dietary diversity and may reduce stunting. It is very uncertain whether unconditional cash transfers reduce the proportion of household expenditure on food or reduce wasting. Evidence from one study indicates that unconditional cash transfers reduce the proportion of infants who are overweight.
Conditional cash transfers make little to no difference in the proportion of household expenditure on food and slightly improve cognitive function in children, probably slightly improve dietary diversity, and may make little to no difference to stunting or wasting. Evidence from two studies shows that conditional cash transfers make no difference to the proportion of overweight children.
Income generation strategies make little or no difference to stunting or wasting, may result in little to no difference to food security and may improve dietary diversity in children but not for households.
Food vouchers probably reduce stunting, may slightly improve dietary diversity and may result in little to no difference in wasting.
Food and nutrition subsidies may improve dietary diversity among school children. We are very uncertain about the effects on household expenditure on healthy foods as a proportion of total expenditure on food.
Social support interventions such as community grants probably make little to no difference to wasting and may make little or no difference to stunting. We are very uncertain about the effects of village savings and loans on food security or dietary diversity.
None of the included studies reported on one of the primary outcomes: prevalence of undernourishment.
This review provides policy makers with a comprehensive evidence base to evaluate the effects of a wide range of community-level interventions to address access to food in low- and middle-income countries (LMICs). The body of evidence indicates that UCTs can improve food security but the review authors are less sure about the effects of other interventions. Some limitations of the review include not having all necessary information about what outcomes the studies measured, having to make judgements regarding which outcome measures to report and inability to pool the results of all studies reporting on the same outcome. Another limitation was that the review authors were unable to find out what specific intervention features enable or impede the effective implementation of the intervention.
Irena Zakarija Grković, co-director of Cochrane Croatia, and Matko Marušić, head of quality assurance at Cochrane Croatia, both received awards from the city of Split.
The Split City Council, on May 4, 2020, decided that the traditional awards of the city of Split should be given to two members of the Cochrane Croatia. The personal award was given to Irena Zakarija Grković, co-director of Cochrane Croatia, for selfless commitment and work on the popularization of breastfeeding. A second award was given to Matko Marušić, head of quality assurance at Cochrane Croatia, for the book "Mi Hrvati".
Irena is a family medicine specialist and an internationally certified breastfeeding counsultant (IBCLC) and president of the Croatian association of IBCLC breastfeeding consultants (HUSD). She became a specialist in Melbourne, Australia, where she gained twelve years of clinical experience working with various groups of patients, especially people with special needs and Croatian-speaking emigrants. There she also became an internationaly certified breastfeeding consultant. Her areas of scientific, teaching and professional interest are breastfeeding and the protection of mothers and children, evidence-based medicine and education in basic clinical and communication skills, and she has published numerous scientific papers in these areas. She is a member and founder of the National commission for the protection and promotion of breastfeeding at the Croatian Ministry of Health, an educator in the UNICEF program "Baby-Friendly Maternity Hospital" and an assistant professor at the Department of Clinical Skills and co-head of Cochrane Croatia.
Matko is one of the leading Croatian scientists, writer and professor emeritus of the University of Split. He graduated from the University of Zgreb, School of Medicine, where he graduated in 1970 with the Rector's award for Best student. Since 1971 he has been working as an assistant at the Department of Physiology of the School of Medicine in Zagreb, where he received his doctorate in 1976. He became a professor at the School of Medicine in 1980. He is the author of numerous works in the field of medical science as well as literary works. He described his childhood in the book "Snijeg u Splitu", which he dedicated to his eldest son Berislav. The book has been reprinted several times since 1987, and is also read as part of primary school reading. His second book, "Plaču li anđeli?" (1997) was dedicated to his son Stjepan Ljudevit. In that book, he described the horrors of the Croatian War of Independence and described the people who fought against and evil and superior enemy, and the victory of good people. Since he wrote books for his children, he also wrote the book "Škola plivanja" for his youngest daughter Maria Franka. In that book, which was published in 2005, she describes Marija’s growing up, narrating innocently and with parental love. In 2006, he published the book "Medicina iznutra", in which he spoke openly about various aspects of life in medical profession, including corruption. In 2019, he published the book "Mi Hrvati" as his long-term project made out of love for the Croatian people. As a professor at the School of Medicine in Zagreb, he was elected vice dean of regional medical studies in Split and Osijek in 1982 and is credited with founding today's School of Medicine in Split (1997), where he was dean from 2009 to 2010 and the School of Medicine in Osijek (1998). He also provided significant assistance in establishing the School of Medicine of the University of Mostar. In 1990, he started Croatian Medical Journal, which he edited and managed until 2011. He has published over 250 scientific papers, of which more than 190 in internationally indexed journals. His most internationally recognized scientific contribution is in the research of the thymus, and on immunology in bone marrow transplantation.
We warmly congratulate Irena and Matko on the great recognition of the city of Split!
Are psychological interventions effective and safe for adolescents with psychosis? Are there any differences in effect between different psychological interventions? New Cochrane systematic review looks at the available evidence.
Psychosis is a mental illnesses characterised by alterations in thoughts and perceptions as delusions (false beliefs), hallucinations (seeing or hearing things that others do not see or hear) and can happen during adolescence. When this happens, the young person needs to see a mental health professional who will often prescribe medications. However, along with medications, adolescents with psychosis are likely to benefit from age‐appropriate psychological treatments (talking treatments) such as cognitive remediation therapy, psychoeducation, family therapy and group psychotherapy. These interventions can address social and psychological needs such as integration with peers and deal with the stigma and exclusion. We have reviewed the effects of these interventions for young people with psychosis using data from randomised controlled trials.
The Information Specialist of Cochrane Schizophrenia searched their trials register in May 2016 and March 2019 for trials that randomly allocated adolescents with psychosis to various treatment groups. The treatment groups could include either psychological interventions (with or without their usual treatment), medications alone, treatment‐as‐usual or other psychological interventions (with or without usual treatment).
This review includes only seven trials conducted in various parts of the world. The trials compared a variety of different psychological interventions with treatment‐as‐usual or with other types of psychological interventions, and they reported different outcome measures, making it difficult for us to compare one study with another. We were interested in the effect these treatments have on seven main outcomes: global state, mental state, adverse effects, cognitive functioning, global functioning, service use, and leaving the study early. None of the included studies reported adverse effect data.
Absolute effect of psychological interventions (PIs, comparing PIs with treatment‐as‐usual (TAU))
Our analyses of reported data suggests that cognitive remediation therapy may help improve short term memory (a cognitive function) but treatment‐as‐usual may be better than CRT for improving mental state. Group therapy may be also be useful for improving global state. All other analyses for the main outcomes showed PIs had little or no effect compared to TAU.
Relative effects of PIs (comparing one type of PI with another type of PI)
Our analyses showed no real differences between the different types of PIs.
Some psychological interventions may have beneficial effects for selected outcomes but, overall, most results suggest little or no effect. However, all our results were based on data from a very small number of studies with small numbers of participants. We also have concerns with the methods used in these studies. Thus, there is considerable uncertainty about the reliability of these findings. We cannot make firm conclusions based on this evidence. Relevant well‐conducted randomised controlled trials are needed.
Cochrane invites expression of interest in joining our Conflict of Interest Panel. This independent panel will work with Cochrane’s Research Integrity Team to arbitrate on potential breaches of the revised Cochrane Conflict of Interest Policy for Cochrane Library Content and provide general guidance on how the policy should be applied. The panel will be take up it’s duties when the revised policy is launched in October 2020.
The panel will work on a voluntary basis and have a maximum of four persons and will be appointed by the Editor in Chief (EIC) in consultation with the Senior Research Integrity Editor. The panel members will select a chair from among the membership of the panel. The Chair will be the main contact person for the panel, will convene virtual or face-to-face meetings of the panel, and consult with the panel as needed.
The duties of the panel are as follow:
- Review cases and make decisions on individual cases referred according to specified time frames.
- Respond to queries about the COI policy generally
- Comment on revisions of the COI policy
- Provide advice when the Editorial & Methods Dept conducts an audit of compliance to the policy
- Prepare an annual report of Panel activity for the EiC
- Participate in training activities that support those creating Cochrane Library content to adhere to the policy
- Assist in the development of supporting materials (e.g. FAQs)
Applicants must have no financial conflicts of interest. In addition the following knowledge and/or experience are desirable:
- Experience serving on or chairing a COI committee or its equivalent (or similar committees. such as academic-industry relations committees)
- Experience with drafting and / or implementing conflict of interest policies (ideally related to research or health policies, such as guidelines)
- Familiarity with the literature on identifying, managing and impact of conflicts of interest in health
- Familiarity with journal policies related to conflicts of interest
- Experience as a Cochrane member or knowledge of Cochrane
Variable, estimated at 3-4 hours per month, which includes attendance at meetings as necessary.
Duration of term
The term of the Panel members is two years, with the possibility of another two-year term, to a maximum of four years.
Administrative support and co-ordination will be provided by the Research Integrity Team, in the Editorial & Methods Department.
Submissions & closing date
Any questions about panel membership and expressions of interest (in the form of a brief cover letter) should be submitted to COIarbiter@cochrane.org
Deadline for expressions of interest: July 31st, 2020
The work of healthcare professionals (e.g. nurses, physicians, psychologists, social workers) can be very stressful. They often carry a lot of responsibility and are required to work under pressure. This can adversely affect their physical and mental health. Interventions to protect them against such stresses are known as resilience interventions. Previous systematic reviews suggest that resilience interventions can help workers cope with stress and protect them against adverse consequences for their physical and mental health.
Cochrane review authors asked, “do psychological interventions designed to foster resilience improve resilience, mental health and other factors associated with resilience in healthcare professionals?” This question is particularly relevant at the moment, when healthcare workers are under great pressure due to COVID-19.
Review authors searched for studies up to June 2019. They found 44 studies that tested a range of resilience interventions. Thirty-nine studies included healthcare professionals only (6892 participants). Four studies included healthcare professionals and non‐healthcare workers (1000 participants). The remaining study examined 82 volunteer emergency workers.
Nineteen studies compared a combined resilience intervention (e.g. mindfulness and cognitive‐behavioural therapy) with unspecific comparators (e.g. a wait‐list control). Most interventions were performed in face-to-face, in groups, with high training intensity of more than 12 hours or sessions.
The review authors found very low-certainty evidence that resilience training may improve resilience in healthcare professionals, and may reduce symptoms of depression and stress immediately after the end of treatment. Resilience interventions do not appear to reduce anxiety symptoms or improve well‐being. Very few studies reported on the longer‐term impact of resilience interventions. Only three studies examined potential adverse events and found no undesired effects.
Studies used a variety of different outcome measures and intervention designs, making it difficult for the review authors to draw general conclusions from the findings. The evidence that they found in this review is limited and very uncertain. This means that, at present, the review authors have very little confidence that resilience interventions make a difference to healthcare workers’ resilience.
The review authors will include results of an updated search of four key databases carried out in June 2020 when they update their review.
A new systematic review from Cochrane Infectious Diseases Group published today; 'Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease'.
COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. Most people with COVID-19 have a mild to moderate respiratory illness; others experience severe illness, such as COVID-19 pneumonia. Formal diagnosis requires laboratory analysis of nose and throat samples, or imaging tests like CT scans. However, the first and most accessible diagnostic information is from symptoms and signs from clinical examination. If initial diagnosis by symptoms and signs were accurate, the need for time-consuming, specialist diagnostic tests would be reduced.
Symptoms are experienced by patients. People with mild COVID-19 might experience cough, sore throat, high temperature, diarrhoea, headache, muscle or joint pain, fatigue, and loss of sense of smell and taste. Symptoms of COVID-19 pneumonia include breathlessness, loss of appetite, confusion, pain or pressure in the chest, and high temperature (above 38 °C).
Signs are evaluated by clinical examination, and include lung sounds, blood pressure and heart rate.
Often, people with mild symptoms visit their doctor (primary care physician) for an initial diagnosis. People with more severe symptoms might visit a hospital outpatient or emergency department. Depending on their symptoms and signs, patients may be sent home to isolate, may receive further tests or be hospitalised.
Why is accurate diagnosis important?
Accurate diagnosis ensures that people receive the correct treatment quickly; are not tested, treated or isolated unnecessarily; and do not risk spreading COVID-19. This is important for individuals and saves time and resources.
We wanted to know how accurate diagnosis of COVID-19 and COVID-19 pneumonia is in a primary care or hospital setting, based on symptoms and signs from medical examination.
What did we do?
We searched for studies that assessed the accuracy of symptoms and signs to diagnose mild COVID-19 and COVID-19 pneumonia. Studies could include people with possible COVID-19, or people known to have – and not to have – COVID-19. Studies had to be in primary care or hospital outpatient settings only and include at least 10 participants with any symptom or sign that might be COVID-19.
The included studies
We found 16 relevant studies with 7706 participants. The studies assessed 27 separate signs and symptoms, but none assessed combinations of signs and symptoms. Seven were set in hospital outpatient clinics (2172 participants), four in emergency departments (1401 participants), but none in primary care settings. No studies included children, and only one focused on older adults. All the studies confirmed COVID-19 diagnosis by the most accurate tests available.
The review authors searched for studies published from January to April 2020.
The studies did not clearly distinguish mild to moderate COVID-19 from COVID-19 pneumonia, so we present the results for both conditions together.
The results indicate that at least half of participants with COVID-19 disease had a cough, sore throat, high temperature, muscle or joint pain, fatigue, or headache. However, cough and sore throat were also common in people without COVID-19, so these symptoms alone are less helpful for diagnosing COVID-19. High temperature, muscle or joint pain, fatigue, and headache substantially increase the likelihood of COVID-19 disease when they are present.
How reliable are the results?
The accuracy of individual symptoms and signs varied widely across studies. Moreover, the studies selected participants in a way that meant the accuracy of tests based on symptoms and signs may be uncertain.
All studies were conducted in hospital outpatient settings, so the results are not representative of primary care settings. The results do not apply to children or older adults specifically, and do not clearly differentiate between milder COVID-19 disease and COVID-19 pneumonia.
The results suggest that a single symptom or sign included in this review cannot accurately diagnose COVID-19. Doctors base diagnosis on multiple symptoms and signs, but the studies did not reflect this aspect of clinical practice.
Further research is needed to investigate combinations of symptoms and signs; symptoms that are likely to be more specific, such as loss of sense of smell; and testing unselected populations, in primary care settings and in children and older adults.
- Read the full systematic review
- Visit the Cochrane Infectious Diseases Group website
- What are diagnostic test accuracy reviews?
- What is the difference between a Cochrane systematic review of interventions and a Cochrane diagnostic test accuracy review?
- Read all the Cochrane resources and news on COVID-19
Cochrane is proud to recognize participants and collaborators from its global community who have been part of its first Knowledge Translation virtual mentoring programme.
Twelve pairs of mentors and mentees took part in the pilot, coordinated by Cochrane’s Knowledge Translation (KT) Department, between September 2019 and March 2020, with the aim of developing skills, as well as passing on expertise, in knowledge translation.
We were delighted to receive huge interest in the scheme with 38 members of the Cochrane community applying to be mentees and 25 people from within and outside of Cochrane volunteering to act as KT mentors.
Mentors and mentees were matched, received online training and guidance, and then met together over six months to work on their projects. You can read a full summary of the KT Mentoring programme here as well as finding out what happens next with this programme.
We wish to pass on a huge thank you to all our KT mentors and mentees for their hard work and commitment. Here are a few of their stories:
Eve Tomlinson, Network Support Fellow for the Cochrane Cancer Network, has been a mentee in the KT mentorship programme. She worked on a project to map stakeholders for Cochrane Review Groups and the Network overall, with the ultimate goal of facilitating stakeholder engagement in review production and knowledge translation activities in the Network. She says of her decision to undertake this project with the KT mentoring program, “I applied for mentoring in the hope that I would receive guidance from someone with relevant experience to help me deliver the project and ensure it was useful for Cancer CRGs. As someone who enjoys KT, I was also keen to have a fellow KT-enthusiast to speak to about KT within Cochrane!” From the successful completion of this project, Eve worked within the CRG to identify 180 stakeholders working toward common goals in cancer research, and she is working with some cancer CRGs on stakeholder engagement. She wrote a guest blog for Cochrane about this project; read it here.
Michael McEvoy applied for the mentorship program as a dissemination fellow for the Cochrane Anaesthesia Review Group (CARG). Working with his mentor, he undertook to increase engagement with reviews from CARG, combining “background” dissemination (such as writing summaries of reviews for newsletters, social media etc) with big projects (such as promoting reviews to authors of national guidelines). He is most proud of the Regional Anaesthesia Special Collection that he helped create as part of this mentoring program, which became highly relevant during the COVID-19 pandemic and generated significant interest and was widely read. Of the mentoring experience, he says, “It was incredibly useful and the project would not have been as successful without it. The mentoring applies some pressure to make sure you progress with your project without it being challenging or critical. It helped me feel more integrated into Cochrane and meet someone from a different group and it encouraged me to think about how I could continue to work more with Cochrane in the future.”
In summary, participants spoke passionately about how they found virtual mentoring hugely valuable for their own learning and would like to see the programme repeated and more opportunities for developing KT skills in the future. Two-thirds of mentees reported feeling more confident about understanding and applying KT practices in their work, and mentors spoke about feeling valued and developing their own thinking and ideas as a result of having a new challenge.
Recognizing the success of this first programme, Cochrane will form a second cohort of mentoring pairs, and seek applications for participants from September 2020.