Cochrane is in the final year of its multi-year strategic plan, Strategy to 2020. 

Strategy to 2020 has set in motion transformational change in the way Cochrane works at all levels of the organization with the aim of giving us the best chance to achieve our mission. Goal 2 of Strategy to 2020 challenged us to make Cochrane evidence accessible and useful to everybody, everywhere in the world. 

Watch the video below to learn about Cochrane’s knowledge translation activities and the progress we have made toward Goal 2:

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

• Watch video Strategy to 2020: Years of transformation
• Watch video Strategy to 2020 Goal 1: Producing evidence

Monday, September 21, 2020

Many healthcare workers work alone or have little access to colleagues and specialists. This is a common problem for healthcare workers in rural areas or low‐income countries. One possible solution to this problem is to offer healthcare workers advice and support through mobile technologies that allow healthcare workers to get help from colleagues who are not in the same place. For instance, healthcare workers can contact specialists or colleagues with more experience through a phone or the Internet. Healthcare workers can also use their mobile phones or other mobile devices such as tablets.

This systematic review from Cochrane Effective Practice and Organisation of Care looked at if healthcare workers using services through their mobile phones or other mobile devices to communicate with other healthcare workers provide quicker access to healthcare, and improve patient health outcomes. Included in this systematic review are 19 relevant studies, which included more than 5766 people who needed health care. Sixteen studies were from high‐income countries.

Mobile technologies probably slightly decrease the time to deliver health care, as well as the number of face‐to‐face appointments, when compared with usual care, and probably increase the number of people receiving clinical examinations for some conditions, including an eye exam for people with diabetes. Mobile technologies may have little or no impact on healthcare workers' and participants' satisfaction, health status or well‐being.

Daniela Gonçalves-Bradley, lead author of the review says, “This review looks at the evidence for three different healthcare scenarios; primary healthcare workers consulting with hospital specialists, emergency doctors consulting with hospital specialists, and community health workers or home‐care workers consulting with clinic staff. The evidence shows that using mobile phones and devices for the communication between health professionals may improve some outcomes; however our confidence in the effect estimates is limited by the certainty of the evidence. As this is a growing area of work, we hope that there will be more robust studies in a future update that will address data‐sharing and privacy concerns and identify common core outcomes.”

• Read the full systematic review
• Visit Cochrane Effective Practice and Organisation of Care
  
  

Friday, September 18, 2020

Producing high quality synthesised evidence rapidly in relation to COVID-19 is clearly critical if researchers, clinicians, the public and policy makers are to make headway in understanding and managing this new coronavirus.

One key area being addressed by a Cochrane Rapid Review is: Quarantine alone or in combination with other public health measures to control COVID. The initial Rapid Review was published in April 2020. Within months, due to the sheer pace and volume of research being undertaken on COVID-19, an update was needed. The search for new evidence identified an eye-watering 5000 references to assess.
 
Enter Cochrane Crowd: Cochrane’s amazing community of citizen scientists, healthcare students, professionals and researchers who all work together to identify and describe health research.

The Crowd were tasked with assessing the new search results for potential relevance to the review. This task was more challenging than the usual Cochrane Crowd tasks as they were being asked to identify a range of different study designs (for example, modelling studies and observational studies as well as any relevant interventional studies).

Another key difference with this task was the time limit. Cochrane Crowd tasks for reviews usually come with a two-week deadline. For this task, the Crowd were given just 48 hours.

The Crowd completed the task within 22 hours, making over 17,000 individual classifications on records. Sixty-five crowd contributors took part with forty-five screening enough records to earn named acknowledgment in the review. Senior authors of the review,  Barbara Nußbaumer-Steit and Gerald Gartlehner were very impressed: “Wow! That is amazing” and “That is incredible”.

Cochrane Crowd have been helping to identify studies for Cochrane reviews and for Cochrane’s Central Register of Controlled Trials for some time now. This new task helped to demonstrate the potential for increased Crowd involvement in reviews that include study designs other than randomised trials. It also demonstrated the speed at which this unflappable community can work when faced with important questions that need answering.

For more information about Cochrane Crowd, visit https://crowd.cochrane.org

Friday, September 18, 2020

Three new reviews have published on mouthwashes/nasal sprays to protect healthcare workers and patients from COVID-19 infection. Healthcare workers are at the forefront of the COVID-19 crisis, with repeated exposure to individuals who are, or may be, infected, and are therefore at risk themselves.

These workers may be especially at risk when undertaking 'aerosol-generating procedures' (AGPs). This is any medical, dental or patient-care procedure that results in the production of airborne particles (aerosols) from the upper aerodigestive tract (mouth, nose, throat, oesophagus) and lower respiratory tract where the virus is shedding. These can remain suspended in the air and travel over a distance. They may cause infection if they are inhaled. Such procedures therefore create the potential for airborne transmission of infection.

This set of three reviews looks at the use of antimicrobial mouthwashes and nasal sprays

1. by healthcare workers treating patients with suspected or confirmed COVID-19 infection;
2. by patients with suspected or confirmed COVID-19 infection and
3. by patients without suspected or confirmed COVID-19 infection, who are undergoing aerosol-generating procedures (AGPs), and the healthcare workers (HCWs) treating them.

The author team, a collaborative team from Cochrane’s Oral Health and Ear, Nose, Throat groups identified no completed studies for inclusion in any of these systematic reviews, which is not surprising given the relatively recent emergence of COVID-19 infection.

However, the authors did identify a number of ongoing studies, which have been recorded and will be monitored for completion with a view to updating the reviews as the results become available.

Read the reviews:

• Use of antimicrobial mouthwashes (gargling) and nasal sprays by healthcare workers to protect them when treating patients with suspected or confirmed COVID-19 infection
• Antimicrobial mouthwashes (gargling) and nasal sprays administered to patients with suspected or confirmed COVID-19 infection to improve patient outcomes and to protect healthcare workers treating them
• Antimicrobial mouthwashes (gargling) and nasal sprays to protect healthcare workers when undertaking aerosol-generating procedures (AGPs) on patients without suspected or confirmed COVID-19 infection

• Learn more about Cochrane Ear Nose Throat
• Learn more about Cochrane Oral Health

Thursday, September 17, 2020

Cochrane has published an updated special collection of systematic and rapid reviews focused on a range of public health measures to control and prevent the spread of COVID-19. Many countries have adopted combinations of these measures and are faced with the challenge of easing or strengthening each of these measures over the course of the pandemic.

Coronavirus disease 2019 (COVID-19) is caused by a new virus, SARS-CoV-2, that has spread quickly throughout the world. As there is currently no effective treatment or vaccine for COVID-19 other ways of slowing its spread are needed.

 What’s new in the Cochrane’s Special Collection?

Added to the Special Collection are three rapid reviews of the evidence on measures that aim to prevent potentially infected people from transmitting the virus to healthy people:

• Quarantine, where healthy people are separated from other healthy people in case they might have the virus because they either have had contact with a case or have travelled from an area with high transmission rates
• Travel-related control measures, such as border closures, partial travel restrictions and entry/exist screening
• Universal screening of people not seeking care for symptoms, either the general population or a targeted population based on their occupation, for example healthcare workers in hospitals and nursing homes.

What do the rapid reviews tell us?

• Quarantine is important in reducing incidence and mortality during the COVID-19 pandemic
• Travel control measures during the COVID-19 pandemic may have a positive impact on infectious disease outcomes
• One-time screening of healthy people looking for symptoms, temperature, international travel history, exposure to known or suspected infected people, or symptoms plus body temperature is likely to miss people who are infected.

What are the limitations of the evidence?

COVID-19 research is rapidly evolving, but the evidence base is still very uncertain. Evidence about the economic and social harms resulting from these measures is lacking. Much of the evidence currently available to help policy makers with public health decisions is based on mathematical modelling, which relies on making assumptions with imperfect data. Some 'real-life' evidence from observational studies is now available, however the certainty of the evidence from this type of study design is generally low or very low because the studies are often poorly designed or conducted.

What are the challenges for decision making?

To maintain the best possible balance of public health measures, decision makers must constantly monitor their outbreak situation and assess the impact of the measures implemented. Future research will help to disentangle the effects of these diverse prevention and control measures and will help determine which measures or combinations of measures may work best while minimising the harms to our communities.

More about the rapid reviews

Does quarantine control coronavirus (COVID-2019) either alone or in combination with other public health measures?

• Low-certainty evidence from mathematical modelling studies consistently indicates that quarantine is important in reducing the number of people with COVID-19, but the size of the reduction is uncertain. 
• Estimates range from a minimum reduction in the number of people with the disease of 44%, and a maximum reduction of 96%.

The lead author Barbara Nussbaumer-Streit (Danube University Krems, Austria) said: “We published the first version of this review in April 2020. Since then 22 additional studies on quarantine for COVID-19 have become available. While the number of studies has increased significantly in a short space of time, the evidence base is still limited because most studies on COVID-19 are mathematical modelling studies that make different assumptions on important model parameters. The evidence suggests that implementation of quarantine early on in a pandemic and combining quarantine with other public health measures such as physical distancing, can help slow the spread of COVID-19.  However, it is difficult to determine what combination of measures is the best to reduce the number of cases and deaths.”

• Read the full Rapid Review 
• Read the Plain Language Summary
• Read the Cochrane news item
• View and download the visual abstract
• Watch the video summary

 

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

• Very low-certainty evidence from modelling studies suggests that when implemented at the beginning of an outbreak, cross-border travel restrictions may lead to a reduction in the number of new cases of between 26% to 90%. 
• Observational studies of entry and exit screening evaluated different combinations of symptom-based screening, single (and rarely repeated) PCR swab testing and observation during quarantine.
• Very low-certainty evidence suggests that the proportion of cases detected at the border ranged from 0% to 75%.
• Entry and exit symptom screening measures on their own are not likely to be effective in detecting enough cases to prevent new cases becoming established within the protected region.
• A combination of approaches including symptom screening, quarantine, observation and PCR testing may help to more accurately identify positive cases.

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

• Read the full Rapid Review
• Read the Plain Language Summary
• Read the Cochrane news item
• Watch the video summary

 

How effective is screening for COVID-19?

• This review highlights the uncertainty and variation in accuracy of screening strategies.
• Observational studies evaluated different screening strategies, mainly screening people once rather than repeatedly, and involved either asking about symptoms, international travel, or exposure to a known or suspected case, performing temperature checks, or a rapid point-of-care test.
• Some studies combined screening for symptoms and temperature checks. With any screening strategy a high proportion of infected individuals may be falsely identified as negative.
• Future population-based screening studies will add substantially to our understanding of the effectiveness and accuracy of screening for COVID-19.

Lead author Meera Viswanathan (RTI International, North Carolina, USA) said: “We are unsure whether combined screenings, repeated symptom assessment, or rapid laboratory tests are useful. Because screening can miss people who are infected, public health measures such as face coverings, physical distancing, and quarantine for those who may have contact with an infected person, continue to be very important.”

• Read the full Rapid Review
• Read the Plain Language Summary
• Read the Cochrane news item
• Watch the video summary

Learn more about Cochrane COVID-19 evidence

• Visit the full Cochrane Special Collection 'Coronavirus (COVID-19): infection control and prevention measures'
• Read all the Cochrane resources and news on COVID-19
• Find out more about Cochrane COVID Reviews

  Wednesday, September 16, 2020

Today Cochrane and six global leaders in evidence-based healthcare, led by JBI, are launching a worldwide initiative to create awareness of the need for better evidence to inform healthcare policy, practice and decision making in order to improve health outcomes globally.

The inaugural World Evidence-based Healthcare (EBHC) Day will be held on 20 October 2020 and spotlights the global impact of EBHC on health research, policy, practice and patient outcomes.

In 2020, EBHC is a worldwide movement with hundreds of organisations and tens of thousands of individuals working tirelessly towards improving the science and practice of EBHC for the same aim: to improve health outcomes. 

“World EBHC day is an opportunity for collaboration in the ever-evolving sphere of global health and will provide a platform to discuss and debate the challenges and innovations in evidence-informed approaches to improving health outcomes globally” says Bianca Pilla, World EBHC Day Committee Chair.

The need and demand for EBHC continues to grow rapidly due to increased availability of digital information, better informed patients, introduction of new technologies, increased healthcare costs, complex adaptive health systems and ageing populations. At the same time researchers, policymakers and health professionals continue to grapple with the 17-year research-to-practice gap of implementing clinical research evidence into practice. 

“As a global evidence community, we are working together to close this gap and overcome barriers to advance the use of reliable research evidence to address some of the world’s most serious health challenges,” said Bianca Pilla. 

In 2020, the importance of having the ability to utilise the best available evidence has been highlighted by the rapid implementation of effective hand washing and the correct use of PPE to help fight the spread of COVID-19. Around the world scientists are working together to develop vaccines, researchers have identified and shared hundreds of viral genome sequences, more than 200 clinical trials have been launched, and international evidence synthesis organisations are rapidly synthesising the emerging evidence to assist policymakers in making informed decisions.

“Promoting evidence-informed decision-making is central to Cochrane’s mission and future sustainability, and we are delighted to be coming together with the global evidence community to launch World EBHC Day to advocate for this vital issue.

“The COVID-19 pandemic has really highlighted the critical importance of evidence-informed global health policy and practice,” said Karla Soares-Weiser, Cochrane Editor in Chief.

About World Evidence-Based Healthcare Day 2020

World Evidence-Based Healthcare (EBHC) Day is held on 20 October each year, starting in 2020. It is a global initiative that raises awareness of the need for better evidence to inform healthcare policy, practice and decision making in order to improve health outcomes globally. It is an opportunity to participate in debate about global trends and challenges, but also to celebrate the impact of individuals and organisations worldwide, recognising the work of dedicated researchers, policymakers and health professionals in improving health outcomes.

The theme for World EBHC Day 2020 is ‘from evidence to impact’, with a call to individuals and organisations worldwide to share their experiences of how their work in EBHC has contributed to impact in health research, policy, practice, guidelines or patient outcomes. 

For more information, please visit: https://worldebhcday.org 

Monday, September 14, 2020

Cochrane Library Editor in Chief Karla Soares-Weiser will present on Friday, September 18, as part of an expert panel hosted by the University of New Mexico addressing the question, "What have we learned about COVID-19 transmission?" 

The panel discussion, moderated by WHO Chief Scientist Soumya Swaminathan, is part of the ECHO COVID-19 GLOBAL CONVERSATIONS series from Project Echo at the University of New Mexico in the United States. The other distinguished panelists include Jay Butler, Deputy Director, US Infectious Diseases, Centers for Disease Control and Prevention; George Gao, Director-General, Chinese Center for Disease Control and Prevention (Chinese CDC); Anne von Gottberg, Co-head, Center for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases; and Marion Koopmans, Head of Department of Viroscience, Erasmus MC. 

The session is open to all interested; it will be held September 18, 08:00 - 09:30 MDT (14:00-15:30 GMT).

• View a poster for the webinar
• Register for the webinar
• Learn more about the webinar series

Monday, September 14, 2020

Do education and training programs reduce aggressive behavior toward healthcare workers?

What is aggressive behavior?

The International Labour Organization uses the term "workplace violence" defined as "any action, incident or behaviour that departures from reasonable conduct in which a person is threatened, harmed, injured in the course of, or as a direct result of, his or her work". Experiencing aggressive behavior at work can affect people's ability to do their job well, can cause physical and mental health problems, and can also affect home life. Aggressive behavior may lead to absences from work; some people might leave their job if they experience aggressive behavior.

Why do this Cochrane Review?

Aggressive behavior exhibited by patients and their families, friends, and carers is a serious problem for healthcare workers. It may affect the quality and safety of the care that healthcare workers can provide.

Education and training programs have been developed to try to reduce—or eliminate—aggressive behavior at work. These programs are intended to teach and train healthcare workers about:

• their organization's policies and procedures;
• how to assess risks; and
• strategies to control or reduce the chances—and effects—of experiencing aggressive behavior.

What did authors do?

The authors searched for studies that investigated how well education and training programs prevented or reduced aggression toward healthcare workers.

They included randomized controlled studies, in which the programs that people received were decided at random and studies in which effects of a program were measured before and after among people who completed the program and in another group of people who did not take part.

They wanted to know if education and training programs could:

• reduce the number of incidents of aggressive behavior in healthcare workplaces;
• improve healthcare workers' knowledge, skills, and attitudes toward aggressive behavior; and
• reduce any personal adverse (unwanted or negative) effects noted among healthcare workers who experienced aggressive behavior.

Evidence published up to June 2020 was included.

What they found

Authors found nine studies including 1688 healthcare workers (including healthcare support staff, such as receptionists) who worked with patients and patients' families, friends, and carers. These studies compared the effects of receiving an education and training program to the effects of not receiving such a program.

Studies were conducted in hospitals or healthcare centers (four studies), in psychiatric wards (two studies), and in long‐term care centers (three studies) in the United States, Switzerland, the United Kingdom, Sweden, and Taiwan.

All programs combined education with training provided either online (four studies) or face‐to‐face (five studies). In eight studies, the people taking part were followed for up to three months (short‐term), and in one study for over one year (long‐term).

What are the results of this review?

Education and training programs did not reduce the number of reports of aggressive behavior toward healthcare workers (five studies), possibly because these programs made healthcare workers more likely to report these incidents.

An education and training program might improve healthcare workers’ knowledge of aggressive behavior in the workplace in the short term (one study), but it is uncertain whether this would be a long‐term effect (one study).

Education programs might improve healthcare workers' attitudes toward aggressive behavior in the short term (five studies), although these results varied depending on the type and length of the program provided.

Education programs might not affect healthcare workers' skills in dealing with aggressive behavior (two studies) and might not affect whether unwanted or negative personal effects were noted after healthcare workers experienced aggressive behavior (one study).

How reliable are these results?

The authors are not confident in the results of this review because these results were reported from a small number of studies—some with small numbers of participants—and because some studies showed large differences in results. They identified problems involving the ways some studies were designed, conducted, and reported. These results are likely to change if further evidence should become available.

Key message

Although an education and training program might increase healthcare workers' knowledge and positive attitudes, such a program might not affect the number of incidents of aggressive behavior that healthcare workers experience.

More studies are needed, particularly in healthcare workplaces with high rates of aggressive behavior.

• Read the full review on the Cochrane Library
• Learn more about Cochrane Work

Friday, September 11, 2020

This role is an exciting opportunity to make a difference in the field of health care research. 

The Assistant Editor will support the Cochrane's central editorial team with editorial and publishing activities.

Responsibilities include:

• Managing editorial workflows for selected content for the Cochrane Library from submission through to publication, working with authors, editors, and production teams, to ensure that content is published on time and to a high standard.
• Working with editorial colleagues and our publisher to support the regular publication cycles for Cochrane
• Library-related products, completing tasks needed to ensure products publish on schedule.
• Using content management systems to edit and publish supporting content and documentation on the
• Cochrane Library and other Cochrane internal and public-facing websites.
• Helping respond to editorial and publishing queries from the Cochrane community

We are looking for a self-motivated and highly organized individual who is able to work effectively, collaboratively and remotely with diverse contacts around the world. The successful candidate will also have:

• Degree in relevant field or equivalent experience.
• Previous experience in a similar editorial or publishing role
• An ability to develop and maintain working relationships with key stakeholders.
• Strong organization and prioritization skills.
• Excellent written and verbal communication skills.
• Proficient level IT skills, including but not limited to Word, Excel, and PowerPoint; and able to quickly adopt to different IT packages being used by the organization such as website content management systems (e.g. Drupal, Confluence).
• Ability to work methodically and accurately with attention to detail.
• A pro-active approach to problem-solving.

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

For further information on the role and how to apply, please click here.  The deadline to receive your application is by 17th September 2020.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples. Note that we will assess applications as they are received, and therefore may fill the post before the deadline.

• Deadline for applications: 20th September 2020 (12 midnight GMT)
• Interviews to be held on: W/C 21st September 2020 (TBC)

Friday, September 11, 2020

How effective is screening for COVID-19?

Why does screening matter?

Screening aims to identify a condition in people who may not be showing any symptoms. Some people may have the COVID-19 virus but appear healthy or have only mild symptoms. It is important to identify infected people so they can stay away from others and seek appropriate care. Incorrectly identifying COVID-19 in healthy people could lead to unnecessary self-isolation and further tests. Incorrectly identifying no infection in infected people could spread the virus.

Screening for COVID-19 can include temperature checks, or asking about international travel or contact with COVID-19 cases, or rapid tests. Screening can occur over the telephone, online, or in person, in homes, clinics, workplaces, airports or schools.

What did the review study?

The author team wanted to identify:

• the benefits and negative effects of screening apparently healthy people for COVID-19 infection
• whether screening can identify those with and without the virus correctly.

To answer these questions rapidly, the authors shortened some steps of the normal Cochrane Review process. They are confident these changes do not affect the overall conclusions.

What did the author team do?

They looked for studies that screened people who had not sought care for potential COVID-19 symptoms.

This review includes evidence up to May 2020.

Key results

The authors found 22 studies; 17 assessed people (cohort studies) and five were computer-generated models (modelling studies). Studies took place in USA, Europe, and Asia.

Benefits and negative effects

Two modelling studies reported on the benefits and negative effects of screening. One suggested that asking about symptoms at airports may slightly slow, but not stop, the importation of infected people.

Another model reported that weekly or biweekly screening of healthcare workers may reduce transmission to patients and other healthcare workers in emergency departments.

No studies reported on negative effects of screening.

Identification of infected people

Seventeen cohort studies and three modelling studies reported on whether screening can correctly identify those with and without the virus. Studies varied widely in the baseline level of COVID-19, settings, and methods. All cohort studies compared screening strategies to a ‘gold standard’ test called RT-PCR.

Cohort studies

All screening strategies (17 studies, 17,574 people), incorrectly identified:

• between 20 and 100 out of 100 infected people as healthy
• between 0 and 38 people out of 100 healthy people as infected

 Asking about symptoms (13 studies, 16,762 people ), incorrectly identified:

• between 40 to 100 out of 100 infected people as health
• between 0 to 34 out of 100 healthy people as infected

Temperature measurements, asking about international travel, exposure to known infected people and exposure to known or suspected infected people (6 studies, 14,741 people), incorrectly identified

• between 77 and 100 out of 100 infected people as health
• between 0 and 10 out of 100 healthy people as infected

 Asking about symptoms plus temperature measurement (2 studies, 779 people), incorrectly identified:

• between 31 and 88 out of 100 infected people as health
• between 0 to 10 people out of 100 healthy people as infected

There was insufficient evidence from two small studies on rapid laboratory tests and repeated symptom assessment to tell how accurate they were in identifying healthy and infected people.

Modelling studies

Three studies modelled entry and exit screening in airports. One study missed 70% of infected travellers. Another detected 90% of infections, but used an unrealistic scenario. The third used very unreliable methods so the authors cannot use evidence from this study.

How confident are we in the results of the studies?

Our confidence in these findings is limited because most studies did not describe their screening methods clearly, some found very few cases of infections and the types of participants and settings varied greatly, making it difficult to judge whether the results apply broadly.

Authors’ conclusions

One-time screening in apparently healthy people is likely to miss people who are infected. The author team are unsure whether combined screenings, repeated symptom assessment, or rapid laboratory tests are useful.

As more people become infected, screening will identify more cases. However, because screening can miss people who are infected, public health measures such as face coverings, physical distancing, and quarantine for those who are apparently healthy, continue to be very important.

Lead author Meera Viswanathan (RTI International, North Carolina, USA) said: “We are unsure whether combined screenings, repeated symptom assessment, or rapid laboratory tests are useful. Because screening can miss people who are infected, public health measures such as face coverings, physical distancing, and quarantine for those who may have contact with an infected person, continue to be very important.”

• Read the full Rapid Review
• View the Cochrane Public Health website
• Read all the Cochrane resources and news on COVID-19
• Find out more about Cochrane COVID Reviews

Tuesday, September 15, 2020

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

What are travel-related control measures?

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

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

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

What did the authors want to find out?

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

What the authors did

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

Authors included studies published up to 26 June 2020.

What the authors found

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

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

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

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

How reliable are these results?

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

What this means

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

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

• Read the full Rapid Review
• View the Special Collection 'Coronavirus (COVID-19): infection control and prevention measures'
• View the Cochrane Public Health website
• Read all the Cochrane resources and news on COVID-19
• Find out more about Cochrane COVID Reviews

Wednesday, September 16, 2020

Cochrane is in the final year of its multi-year strategic plan, Strategy to 2020. 

Strategy to 2020 has set in motion transformational change in the way Cochrane works at all levels of the organization with the aim of giving us the best chance to achieve our mission. Goal 1 of Strategy to 2020 gets to the heart of Cochrane’s work: To produce high-quality, relevant, up-to-date systematic reviews, and other synthesized research evidence to inform health decision making.

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

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

Watch video Strategy to 2020: Years of transformation

Thursday, September 10, 2020

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

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

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

 

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

Systematic review: Behavioural activation therapy for depression in adults

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

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

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

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

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

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

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

 

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

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

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

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

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

Future directions for Cochrane Common Mental Disorders

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

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

Wednesday, September 9, 2020

Cochrane Heart Author in Residence: Mehul Srivastava

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

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

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

Read the transcript 

• Visit the Cochrane Heart website
• Learn more about in-person and virtual placements at Cochrane groups via our Cochrane International Mobility Programme

Tuesday, September 8, 2020

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

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

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

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

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

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

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

For further information on the role and how to apply, please click here.  The deadline to receive your application is by 20th September 2020.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples. Note that we will assess applications as they are received, and therefore may fill the post before the deadline.

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

Tuesday, September 8, 2020 Category: Jobs

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

What is obesity?

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

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

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

What are fats?

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

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

Health guidelines usually recommend that people should:

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

Why we did this Cochrane Review

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

What did we do?

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

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

Search date:

We included evidence published up to September 2019.

What we found

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

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

What are the results of our review?

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

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

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

How reliable are these results?

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

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

Conclusions

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

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

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

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

• Read the full review on the Cochrane Library
• Learn more about Cochrane Public Health

Friday, September 11, 2020

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

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

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

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

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

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

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

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

 

 

Thursday, September 10, 2020

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

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

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

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

• Read the WHO guideline
• Visit the Cochrane Pregnancy and Childbirth website

Tuesday, September 1, 2020

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

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

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

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

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

• Read the full Cochrane Review
• Learn more about Cochrane Anaesthesia and Cochrane Emergency and Critical Care

Tuesday, September 1, 2020

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

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

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

What does the evidence tell us?

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

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

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

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

What implications are there for further research?

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

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

What message can policy-makers take from this study?

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

• Read the full Cochrane Review
• Learn more about the Cochrane Pain, Palliative and Supportive Care Group

Friday, August 28, 2020