Stroke is a leading cause of death and disability worldwide. The chances of having a stroke increase with age and older people also appear to suffer greater consequences from COVID-19. There may be a link between COVID-19 and new strokes, so healthcare professionals may be caring for people who have both COVID-19 and stroke.
Cochrane Stroke heard from stroke care professionals and researchers that it was difficult to find relevant material amongst the thousands of articles available. To address this need, they collated useful resources for stroke care teams on their website. In addition, they made it easier for people to find relevant publications themselves by creating search strategies for stroke and Covid-19 for major databases including Google, MEDLINE, Pubmed, ClinicalTrials.gov, and The Cochrane Library.
- Learn more about how Cochrane Stroke approached this challenge, and what they learned in the process in this short case story.
Cochrane provides high-quality, relevant and up-to-date synthesized research evidence to inform health decisions. This page highlights the many ways that Cochrane has successfully responded to COVID-19 around the world. Click on any of the case studies below to find out more, and check back often as we continuously add and update new stories.
Making COVID-19 evidence easier to find - Cochrane Stroke heard from stroke care professionals and researchers that it was difficult to find relevant material amongst the thousands of articles available. Learn how Cochrane Stroke addressed this challenge.
Making sure COVID-19 evidence is available in people’s preferred language - Cochrane published a rapid review about whether cleaning hands with ash reduces the spread of COVID-19 and other infectious diseases in areas where soap is not widely available. Read how Cochrane First Aid made sure this evidence was available to people in their preferred language.
Shaping and sharing COVID-19 evidence with social media - Cochrane China used the mobile telephone social media app WeChat to find out what doctors, nurses and members of the public wanted to know about COVID-19 and to share evidence with them. Learn more about what Cochrane China achieved by harnessing the power of social media during a pandemic, and what they learned in the process.
Tuesday, November 24, 2020 Category: The difference we make
What are routine laboratory tests?
Routine laboratory tests are blood tests that assess the health status of a patient. Tests include counts of different types of white blood cells (these help the body fight infection), and detection of markers (proteins) that indicate organ damage, and general inflammation. These tests are widely available and in some places they may be the only tests available for diagnosis of COVID-19.
What did the authors want to find out?
People with suspected COVID-19 need to know quickly whether they are infected so that they can self-isolate, receive treatment, and inform close contacts.
Currently, the standard test for COVID-19 is usually the RT-PCR test. In the RT-PCR, samples from the nose and throat are sent away for testing, usually to a large, central laboratory with specialist equipment. Other tests include imaging tests, like X-rays, which also require specialist equipment.
The authors of this review wanted to know whether routine laboratory tests were sufficiently accurate to diagnose COVID-19 in people with suspected COVID-19. They also wanted to know whether they were accurate enough to prioritize patients for different levels of treatment.
What did the author team do?
Authors searched for studies that assessed the accuracy of routine laboratory tests to diagnose COVID-19 compared with RT-PCR or other tests. Studies could be of any design and be set anywhere in the world. Studies could include participants of any age or sex, with suspected COVID-19, or use samples from people known to have – or not to have - COVID-19.
What authors found
The authors found 21 studies that looked at 67 different routine laboratory tests for COVID-19. Most of the studies looked at how accurately these tests diagnosed infection with the virus causing COVID-19. Four studies included both children and adults, 16 included only adults and one study only children. Seventeen studies were done in China, and one each in Iran, Italy, Taiwan and the USA. All studies took place in hospitals, except one that used samples from a database. Most studies used RT-PCR to confirm COVID-19 diagnosis.
Accuracy of tests is most often reported using ‘sensitivity’ and ‘specificity’. Sensitivity is the proportion of people with COVID-19 correctly detected by the test; specificity is the proportion of people without COVID-19 who are correctly identified by the test. The nearer sensitivity and specificity are to 100%, the better the test. A test to prioritize people for treatment would require a high sensitivity of more than 80%.
Where four or more studies evaluated a particular test, the authors of this review pooled their results and analyzed them together. Their analyses showed that only three of the tests had both sensitivity and specificity over 50%. Two of these were markers for general inflammation (increases in interleukin-6 and C-reactive protein). The third was for lymphocyte count decrease. Lymphocytes are a type of white blood cell where a low count might indicate infection.
How reliable are the results?
Confidence in the evidence from this review is low because the studies were different from each other, which made them difficult to compare. For example, some included very sick people, while some included people with hardly any COVID-19 symptoms. Also, the diagnosis of COVID-19 was confirmed in different ways: RT-PCR was sometimes used in combination with other tests.
How up-to-date is this review?
The authors searched all COVID-19 studies up to 4 May 2020.
Who do the results of this review apply to?
Routine laboratory tests can be issued by most healthcare facilities. However, these results are probably not representative of most clinical situations in which these tests are being used. Most studies included very sick people with high rates of COVID-19 virus infection of between 27% and 76%. In most primary healthcare facilities, this percentage will be lower.
What does this mean?
Routine laboratory tests cannot distinguish between COVID-19 and other diseases as the cause of infection, inflammation or tissue damage. None of the tests performed well enough to be a standalone diagnostic test for COVID-19 nor to prioritize patients for treatment. They will mainly be used to provide an overall picture about the health status of the patient. The final COVID-19 diagnosis has to be made based on other tests.
Implications for practice
None of these markers as stand‐alone tests are useful for accurately ruling in or ruling out COVID‐19. As a triage test would require a high sensitivity (< 80%), these tests have limited value as triage tests. Although there is low or very low certainty about the summary estimates in this review, we do not expect that studies with a low risk of bias will show a better performance than the tests included.
Implications for research
Future studies focusing on the usefulness of routine laboratory tests for COVID‐19 may consider a more representative sample of the population, focus on markers with prespecified, clinically sound cut‐offs and focus on single, but also on the combination of regular blood markers. Furthermore, considering the test results as continuous values may be more informative, as larger deviations from the reference values will have greater impact on the health status of the tested people, and might enable more personalized treatment.
In 2016, Cochrane Pregnancy and Childbirth published a systematic review looking at if skin-to-skin contact improved breastfeeding rates and helped babies adjust to the outside world. They looked at the results of 46 studies which included almost 4000 mothers and their babies. Overall, their review supports the use of skin-to-skin to encourage breastfeeding. The evidence suggests that early skin-to-skin should be normal practice for healthy newborns including those born by caesarean and babies born early at 35 weeks or more. Even where skin-to-skin is possible only for a short time, it will still encourage successful breastfeeding one to four months post birth. Importantly, the findings of improved breastfeeding rates were found in diverse countries and among women of low and high socio-economic class.
Since publication, this review has informed 20 sets of guidelines around the world, with the World Health Organisation (WHO) referencing the review in their 2017 guidance for promoting and supporting breastfeeding. It has been translated into five languages.
Elizabeth Moore, Associate Professor of Nursing at Vanderbilt University School of Nursing and lead author of the review said:
"I have really been amazed at the impact that this Cochrane Review has had around the world. It started as just a gut feeling I had as a breastfeeding consultant over 20 years ago that placing mothers and babies together skin-to-skin right after birth would help them breastfeed more successfully. Since then, this profound, but simple intervention has spread throughout the world based on the evidence in this review.”
In the UK, NICE has used the evidence in their 2006 guidance, and the latest revision in 2015, with the recommendation that women have skin-to-skin contact with their babies after birth. The Royal College of Nursing, UNICEF and Public Health England have all cited the research to promote skin-to-skin contact after birth. As a result, a 2019 survey by the Care Quality Commission reported that 93% of women in England had skin-skin contact after birth.
In June 2020, the WHO stated that skin-to-skin contact and breastfeeding should still be encouraged for new mothers and their babies in cases of suspected or confirmed COVID-19. Early evidence suggests that the benefits of skin-to-skin and breastfeeding far outweigh any risks.
- Read the full Cochrane Review: Early skin‐to‐skin contact for mothers and their healthy newborn infants
- Read the Plain Language summary in English, Deutsch, Español, Français, Hrvatski, 日本語, 한국어, Bahasa Malaysia, Português, Русский, ภาษาไทย, and 繁體中文
- Visit the Cochrane Pregnancy and Childbirth Website
- Listen to the lead author explain the results
- Read 'Case study: Skin-to-skin contact to encourage breastfeeding' on NIHR
Why is this question important?
Basal cell carcinoma (BCC) is the most common form of skin cancer among people with white skin.
BCC is not usually life‐threatening but if left untreated, it can cause important disfigurement, especially on the face.
Surgical removal of the affected area and surrounding skin is usually the first option for treating BCC. Several different surgical approaches exist as well as non‐surgical treatments, such as radiotherapy (high doses of radiation that kill cancer cells), and anti‐cancer creams, gels and ointments.
We reviewed the evidence from research studies, to find out which treatments work best for BCC.
How did we identify and evaluate the evidence?
We searched for randomised controlled studies (studies where people are randomly put into one of two or more treatment groups), because these provide the most robust evidence about the effects of a treatment. We compared and summarised the evidence from all the studies. Finally, we rated our confidence in the evidence, based on factors such as study methods and sizes, and the consistency of findings across studies.
What did we find?
We found 52 studies that involved a total of 6690 adults with BCC. Most studies (48 out of 52) included hospital outpatients with small, superficial or nodular BCC. Studies lasted for between six weeks and 10 years (average duration: 13 months). Twenty‐two studies were funded by pharmaceutical companies.
Our confidence in the evidence presented here is low to moderate, mainly because many studies were small.
Comparison between different surgical treatments
- Mohs micrographic surgery (a specialised surgical approach that removes less skin) may slightly decrease recurrence rates at three and five years compared to surgical excision (one of the most common surgical treatments for BCC).
- There may be little to no difference in how well scars heal between these two surgical treatments according to patients and observers (one study).
Surgery versus non‐surgical treatments
Compared against surgical excision:
- Imiquimod (an anti‐cancer cream) probably increases BCC recurrence rates at three and five years. There may be little to no difference in scar healing according to patients, although imiquimod may increase chances of scars healing well when healing is rated by an observer (one study).
- Radiotherapy may increase BCC recurrence rates at three and four years, and probably decreases chances of scars healing well (one study).
- MAL‐PDT, a type of photodynamic therapy (that uses a light source and light‐sensitive medicine to kill cancer cells), may increase BCC recurrence rates at three years. MAL‐PDT probably increases chances of scars healing well (two studies).
Comparison of different non‐surgical treatments
Compared against imiquimod:
- MAL‐PDT probably increases BCC recurrence rates at three and five years. There is probably little to no difference in scar healing (one study);
What does this mean?
Overall, the evidence suggests that:
- surgery could reduce chances of BCC recurrence;
- non‐surgical treatments such as anti‐cancer creams or photodynamic therapy carry an increased chance of BCC recurrence, but could increase chances of scars healing well compared with surgery.
Complications with surgical treatments include wound infections, skin graft failure and bleeding after the procedure. Non‐surgical treatments frequently lead to localised itching, weeping, pain and redness. Treatment‐related side effects that caused modifications to the study or the withdrawal of participants occurred with imiquimod and MAL‐PDT.
How‐up‐to date is this review?
The evidence in this Cochrane Review is current to November 2019
An updated Cochrane review published today in the Cochrane Library summarizes randomized trial evidence about face masks, hand washing and physical distancing to interrupt or reduce the spread of respiratory viruses. The review will inform revised guidance due to be released by the World Health Organisation.
Lisa Bero, Cochrane Public Health and Health Systems Senior Editor and an author on an Editorial published to accompany this review said, “The results of this review should be interpreted cautiously, and the uncertain findings should not be taken as evidence that these measures are not effective. Most of the trials looked at the effects of measures like face masks and hand washing on their own, however no single measure alone will be enough to reduce the spread of COVID-19. Public health decision makers need to consider all of the available evidence and are likely to act on uncertain evidence if the intervention has the potential to protect the health of large populations and it is unlikely to lead to very serious harm.”
What are respiratory viruses?
Respiratory viruses are viruses that infect the cells in your airways: nose, throat, and lungs. These infections can cause serious problems and affect normal breathing. They can cause flu (influenza), severe acute respiratory syndrome (SARS), and COVID-19.
How do respiratory viruses spread?
People infected with a respiratory virus spread virus particles into the air when they cough or sneeze. Other people become infected if they come into contact with these virus particles in the air or on surfaces on which they have landed. Respiratory viruses can spread quickly through a community, through populations and countries (causing epidemics), and around the world (causing pandemics).
How can we stop the spread of respiratory viruses?
Physical measures to try to stop respiratory viruses spreading between people include:
- washing hands often;
- not touching your eyes, nose, or mouth;
- sneezing or coughing into your elbow;
- wiping surfaces with disinfectant;
- wearing masks, eye protection, gloves, and protective gowns;
- avoiding contact with other people (isolation or quarantine);
- keeping a certain distance away from other people (distancing); and
- examining people entering a country for signs of infection (screening).
Why the authors did this Cochrane Review
The authors of this review wanted to find out whether physical measures stop or slow the spread of respiratory viruses.
What did authors do?
The authors searched for studies that looked at physical measures to stop people catching a respiratory virus infection.
They were interested in how many people in the studies caught a respiratory virus infection, and whether the physical measures had any unwanted effects.
Search date: This is an update of a review first published in 2007. We included evidence published up to 1 April 2020.
What the authors found
Review authors identified 67 relevant studies. They took place in low-, middle-, and high-income countries worldwide: in hospitals, schools, homes, offices, childcare centres, and communities during non-epidemic influenza periods, the global H1N1 influenza pandemic in 2009, and epidemic influenza seasons up to 2016. No studies were conducted during the COVID-19 pandemic. The authors identified six ongoing, unpublished studies; three of them evaluate masks in COVID-19.
One study looked at quarantine, and none eye protection, gowns and gloves, or screening people when they entered a country.
The authors assessed the effects of:
- medical or surgical masks;
- N95/P2 respirators (close-fitting masks that filter the air breathed in, more commonly used by healthcare workers than the general public); and
- hand hygiene (hand-washing and using hand sanitiser).
What are the results of the review?
Medical or surgical masks
Seven studies took place in the community, and two studies in healthcare workers. Compared with wearing no mask, wearing a mask may make little to no difference in how many people caught a flu-like illness (9 studies; 3507 people); and probably makes no difference in how many people have flu confirmed by a laboratory test (6 studies; 3005 people). Unwanted effects were rarely reported, but included discomfort.
Four studies were in healthcare workers, and one small study was in the community. Compared with wearing medical or surgical masks, wearing N95/P2 respirators probably makes little to no difference in how many people have confirmed flu (5 studies; 8407 people); and may make little to no difference in how many people catch a flu-like illness (5 studies; 8407 people) or respiratory illness (3 studies; 7799 people). Unwanted effects were not well reported; discomfort was mentioned.
Following a hand hygiene programme may reduce the number of people who catch a respiratory or flu-like illness, or have confirmed flu, compared with people not following such a programme (16 studies; 61,372 people). Few studies measured unwanted effects; skin irritation in people using hand sanitiser was mentioned.
How reliable are these results?
The authors' confidence in these results is generally low for the subjective outcomes related to respiratory illness, but moderate for the more precisely defined laboratory-confirmed respiratory virus infection, related to masks and N95/P2 respirators. The results might change when further evidence becomes available. Relatively low numbers of people followed the guidance about wearing masks or about hand hygiene, which may have affected the results of the studies.
We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses.
Hand hygiene programmes may help to slow the spread of respiratory viruses.
Reducing the transmission of Coronavirus disease 2019 (COVID-19) is a global priority. Toward this end, public health officials and politicians across the world have been seeking scientific expertise to guide policy. In response, investigators have rushed to share new results on preprint servers, and journals have expedited editorial and peer review processes to publish them. The urgency to define the relevant knowledge base in preventing, diagnosing, and managing COVID-19 infection and its sequelae has required intense collaboration in evidence generation and synthesis, in order to provide public health officials with authoritative guidance.
A newly published Cochrane Library Editorial addresses how Cochrane has responded to the COVID-19 pandemic, what the limitations to COVID-19 evidence are, and suggestions on how policy makers can move forward with best available evidence. This Editorial publishes alongside the updated Cochrane Review 'Physical interventions to interrupt or reduce the spread of respiratory viruses'.
Why is this review important?
Many children and young people experience problems with anxiety. Children and young people with anxiety disorders are more likely than their peers to have difficulty with friendships, family life, and school, and to develop mental health problems later in life. Therapies such as cognitive behavioural therapy (CBT) can help children and young people to overcome difficulties with anxiety by using new ways of thinking and facing their fears.
Who will be interested in this review?
Parents, children, and young people; people working in education and mental health services for children and young people; and general practitioners.
What questions does this review aim to answer?
This review updates and replaces previous Cochrane Reviews from 2005 and 2015, which showed that CBT is an effective treatment for children and young people with anxiety disorders.
This review aimed to answer the following questions:
- Is CBT more effective than a waiting list or no treatment?
- Is CBT more effective than other treatments and medication?
- Does CBT help to reduce anxiety for children and young people in the longer term?
- Are some types of CBT more effective than others? (e.g. individual versus group therapy)
- Is CBT effective for specific groups? (e.g. children with autism)
Which studies were included in the review?
We searched the databases to find all studies of CBT for anxiety disorders in children and young people published up to October 2019. In order to be included in the review, studies had to be randomised controlled trials (a type of study in which participants are assigned to one of two or more treatment groups using a random method) and had to include young people under 19 years of age with an anxiety disorder diagnosis. We included 87 studies with a total of 5964 participants in the analysis.
What does the evidence from the review tell us?
We rated the overall quality of the evidence as 'moderate’ or 'low'. There is evidence that CBT is more effective than a waiting list or no treatment in reducing anxiety in children and young people, although the findings did vary across studies. There is no clear evidence that CBT is more effective than other treatments. A small number of studies looked at outcomes six months after CBT was given and showed that reductions in anxiety continued. We found no clear evidence that one way of providing CBT is more effective than another (e.g. in a group, longer treatments, with parents) or that CBT is more or less effective for any specific group of children (e.g. children with autism spectrum disorders).
What should happen next?
Future research should compare CBT to alternative treatments and medication; identify who does and does not benefit from CBT and what those who do not benefit need; establish how to make CBT more accessible; and give far more consideration to neglected populations, including children and young people from low‐ and middle‐income countries.
Following a session in May, a resumed World Health Assembly is taking place virtually this week (9-14 November).
The World Health Assembly (WHA) is the decision-making body of the World Health Organization (WHO) and is attended by representatives of all Member States.
Our statement pledges support for the Decade of Healthy Ageing and highlights some of the work that the Cochrane Campbell Global Ageing Partnership is undertaking to help strengthen the evidence base in this area.
The full statement is below:
COVID-19 has emphasized the critical importance of evidence-informed global health policy. Governments, healthcare professionals and researchers worldwide continue to seek answers to questions related to the treatment of patients, and how best to protect populations. The pandemic has disproportionately affected older people and has demonstrated the need for and importance of good quality data and evidence to support them.
Cochrane is a global leader in producing high-quality synthesized evidence to inform health decision making. We are working closely with WHO in response to the pandemic by producing rapid reviews and living systematic reviews to answer COVID-19-related priority questions, as well as launching and maintaining one of the largest and most sophisticated registries of COVID-19 studies and a living synthesis of COVID-19 study results. In the area of ageing, the Cochrane Campbell Global Ageing Partnership produces and widely disseminates high-quality, high-priority systematic reviews of all available evidence, identifies evidence gaps and develops methods for evidence synthesis related to ageing. These syntheses will enable informed decision-making and policy development aimed at improving the lives of older people, their families and communities. The impacts of the pandemic clearly show that this work is more crucial now than ever.
The Cochrane Campbell Global Ageing Partnership pledges its commitment to the Decade of Healthy Ageing. We are working with the WHO Ageing and Health team and as members of the International Consortium on Evidence and Metrics for Healthy Ageing. This consortium is playing a key role in strengthening data, research and innovation, generating impact for older people’s health and wellbeing. There are still major evidence gaps and the Decade of Healthy Ageing will allow us to focus on research and innovation for improving the lives and wellbeing of older people.
Rapid research requires teamwork and methodological expertise – Cochrane praised in recent publication
‘A QuESt for speed: rapid qualitative evidence syntheses as a response to the COVID-19 pandemic’ published in BMC Systematic Review
In a recently published article, the research team of a Cochrane rapid qualitative evidence synthesis reflects on their experience and discuss the challenges they were faced with at each stage of the review. The authors describe practical considerations and stress the level of methodological expertise and dedication needed to deliver a qualitative evidence synthesis rapidly and accurately during the COVID-19 pandemic.
Throughout the paper, the team praise the collaborative nature of Cochrane and its importance when working to extreme deadlines in a pandemic situation, as in the excepts below:
"…We highlight the broader team of supporters, including the editors, peer reviewers, translators, healthcare workers, end-user stakeholders, and the broader Cochrane community. The membership of our immediate team and the support we received from the wider community was critical in completing and publishing our review within this timeframe. The core team had worked together previously and this also enhanced our completion trajectory. The merits of conducting rapid research with people who recognise each other’s work ethic, skill sets and personalities receive almost no attention in the literature...
The generosity of everyone to answer this question played a role that cannot be underestimated. In addition, through the Cochrane structure, the team had access to an international network offering specialised methodological and practical support. Cochrane EPOC’s editorial team maintains high levels of QES expertise providing essential guidance for sections of the review, as well as experience in dissemination and end-user input. The Cochrane community was quickly able to identify peer reviewers and copy editors, who contributed within the timeline…."
Kayleigh Kew, Cochrane’s Senior Editor for Methods commented: “The rapid qualitative evidence synthesis described is a true success story. The quality achieved in COVID-19 rapid reviews with such an unforgiving timelines show what is possible when dedicated authors come together with Cochrane’s vast and experienced network of editors and experts. Reflections from Cochrane authors and contributors like those presented in this article help the organization to learn from what has been achieved to continue producing high-quality, relevant syntheses when they are needed most.”
In 2020, people aged 60 years or over outnumber children under 5 years, for the first time in history; and by 2050, it is estimated that there will be more than twice as many people over 60 as children under 5, and outnumber adolescents and young people aged 15–24 years. To mark this change in our global population The World Health Organisation (WHO) Decade of Healthy Ageing has been established.
The WHO defines Healthy Ageing as ‘the process of developing and maintaining the functional ability that enables wellbeing in older age’ and includes creating environments and opportunities for people to be and do what they value for the extent of their lives.
The Cochrane Campbell Global Ageing Partnership has worked with the WHO since 2015, and aims to promote the dissemination, accessibility, and impact of Cochrane and Campbell Reviews, while increasing their applicability to address the health care priorities and wellbeing of older people globally. The Partnership also recognizes a need for producing and disseminating evidence to drive research to address the healthcare, social needs and inequalities of an increasingly older population. Reviews need to reflect the multidisciplinary nature of ageing in order to be relevant and accessible to a wide audience of policymakers, educators, commissioners, funders, and consumers. This decade will highlight and support this work for both Cochrane and the WHO.
Tracey Howe, who is leading this project within Cochrane said,
“This is an opportunity for us to inform and help the WHO when it comes to advice about healthy ageing. We are delighted to partner on this important initiative and focus on having a global impact. Our work will prioritise the major causes of disability affected life years, called DALYS, for people over 50 including cardiovascular disease, stroke, COPD, cancer, Alzheimer’s disease, dementias, diabetes and falls looking at how Cochrane can play it’s part in improving the evidence, and access to this evidence, on these globally important health topics.”Related work
- Read about the WHO Decade of Global Ageing
- Visit The Cochrane Campbell Global Ageing Partnership website
- Cochrane statement to the 73rd World Health Assembly about the Decade of Healthy Ageing
- Prof Tracey Howe appears in Decade of Healthy Ageing ‘Leaders Voices’ video alongside WHO and UN leadership
The Association for Healthcare Social Media (AHSM) is a professional society devoted to the use of social media by healthcare professionals. The multispecialty and multidisciplinary AHSM assists health professionals in utilizing social media platforms to serve as disseminators of accurate health information while doing so responsibly. AHSM members include many of the virtual physicians and nurses of TikTok, Instagram, Twitter, and YouTube who are disseminating important healthcare-related information to their audiences.
We spoke with Austin Chiang, MD, MPH, a founding member of the AHSM and the chief medical social media officer at Jefferson Health, in Philadelphia about AHSM and the role of social media is playing in disseminating health information.
Hi Dr. Chiang, would you mind telling us a bit more about yourself?
Sure! I am a gastroenterology and advanced/bariatric endoscopist by training and currently am an assistant professor of medicine, director of the endoscopic bariatric program, and chief medical social media officer at Jefferson Health in Philadelphia. I completed my undergraduate studies at Duke University, medical school at Columbia University, and internal medicine residency at Columbia, New York Presbyterian Hospital, as well. Thereafter, my gastroenterology and bariatric endoscopy training was completed at Brigham and Women's Hospital, and I received a master's in public health at the Harvard TH Chan School of Public Health. My final fellowship was completed at Jefferson, where I stayed on as faculty.
You sound busy! And you are a founding members of AHSM - how did that get started?
Well, after years of being on social media, many of my colleagues, mainly physicians on Instagram, started noticing concerning trends of people misrepresenting themselves as a health experts without the requisite training. This led to the #verifyhealthcare hashtag campaign, that brought the founders together and led us to consider many other concerning observations we had of health professionals on social media. We were also eager to share with other health professionals how many of us had managed to reach larger audiences by using social media productively.
What does AHSM do?
While many of us are driven by our desire to put forth accurate health information on social media, we are most passionate about helping health professionals use social media effectively and responsibly to meet patients where they are. Without an increased professional presence on social media, misinformation can be easily perpetuated and audiences misled. However, getting health professionals online also requires guidance and incentives. Social media is rapidly evolving and can be time consuming. We therefore felt the need to create a 501(c)(3) professional society to help legitimize social media in health and collaborate with institutions and organizations. In our inaugural year we held a two-day conference, had a co-branded course with YouTube about how to optimize one's experience on the platform, and worked with Cochrane on World Evidence-Based Healthcare Day!
You have 55.4K followers on Instagram and 316.3K on TicTok. But not everyone is convinced that social media is a great way to disseminate health evidence because it’s a ‘serious and complex’ topic. What do you think about this?
People of all age groups are spending more time than ever before on social media. The average time per day exceeds two hours per day on social media. Individuals and advertisers across sectors have capitalized on this usage to promote their services and products. Especially during the pandemic, there has been growing attention in health. Social media is not only a great way to distribute health knowledge, it is absolutely imperative in 2020. "Serious and complex" topics can impact everyone, and without trained individuals to interpret that information, medical misinformation could wreak havoc.
It's been helpful to get a bit of 'social media star' power behind Cochrane with your member's posts. How has it been working closely with Cochrane?
It's been great! Our AHSM members know Cochrane as the ‘gold standard’ in consolidating health evidence through systematic reviews and it's been exciting to share Cochrane evidence and evidence-based medicine principles directly with our lay audience. With the COVID-19 pandemic, everyone is looking for health information online. With additional time spent on social media channels, there is also greater exposure to misinformation and misrepresentation of evidence online. Our members are health professionals that are provided with the tools and training to share health evidence on social media and actively work towards fighting misinformation. The COVID-19 pandemic has underscored the importance of educating our audiences about evidence based healthcare and the high quality evidence that Cochrane provides.
What’s your advice to med students, clinicians and researchers, and scientists in healthcare that are thinking about using social media?
Take it a step at a time. It's ok to observe and reach out to people who you look up to for advice on social media. People who are active on social media are used to putting themselves out there and helping colleagues out. Also, think about your purpose and what you're hoping to achieve. This really dictates which platform is most suitable and what approach to take.
That's great advice. What do you think the benefits are to the creator and to the audience?
The benefits are numerous to both. For the creator, you access the latest information in real time, you build valuable networks, build practices, and participate in riveting conversations. For the audience it may be knowledge and access to health professionals you otherwise might not have had, and opportunities to learn about treatments and trials that would otherwise remain unknown.
We have an 'Early Career Professionals Cochrane Group' who have been especially keen on using social media. How do you think early career professionals can leverage social media?
It depends on how early is early. I think we all develop a different comfort level of when we decide we are "qualified" to educate and discuss about topics online. I think no matter what stage someone is at, there is value. Pre-med and medical students share important perspectives that can inspire those aspiring students behind them, while informing those more senior to them.
Thanks for speaking with us, Dr. Chiang!
If you would like to learn more about AHSM:
If you would like to learn more about social media at Cochrane:
- Free webinar: Leverage Social Media, 18 November
- Get social with Cochrane!
- Cochrane Training social media resources
Thursday, November 12, 2020
We talked to Lauren about her background, the growing 'geek chic' trend, and what it was like working on these new designs for the Cochrane Community.
Hi Lauren, can you tell us a bit about your background?
Sure, I’m a research scientist working in the field of cancer immunotherapy. I have a PhD in Immunology and absolutely love T cells! Before my PhD I completed a BSc in Biology, MSc in Molecular Medicine and an MRes in Inflammation. When I started my undergraduate degree 10 years ago, I never imagined staying in education for so long, but I loved working in the lab so much that I just carried on.
From the lab to designing through Science Scribbles; how did that happen?
Science Scribbles initially started as an educational YouTube channel where I created hand-drawn science tutorials - I called it scribbles as my artistic abilities are very limited on paper! As the online SciComm community enjoyed these, I started to design digital scribbles and create colourful accessories and gifts to help people celebrate science.
We love that more people want to celebrate science. Is 'Geek Chic' really a trend?
Definitely! Scientists and researchers are very passionate and proud of their work and wearing science merch is a great way to outwardly show that. In the past I feel like a lot of science merch was either aimed at children or was too plain or serious. My mission for Science Scribbles is to create lots of fun and chic science accessories that people like myself would want to wear.
Why do you think it’s important to explicitly show support for science?
Openly supporting science and sharing science through science communication and public engagement is crucial as it helps to highlight the important work that scientists do, and to build trusts between scientists and the public. I feel this is even more important at the minute as trust in science is absolutely necessary during the current global pandemic.
Our Cochrane Community has been asking for some merchandise on social media. We were excited to work with someone that understood the passion behind our work and the importance of systematic reviews.
I was excited to work with Cochrane too! A big part of being a scientist is staying up to date with the scientific literature and also contributing to science through publications. Whenever I am looking for publications I often search for Cochrane reviews as these are always highly informative and trusty worthy.
The new Cochrane designs look great!
Thanks! For this project, I particularly wanted to draw attention to the fact that Cochrane is very highly regarded by the scientific community. I hope I was able to visually depict this and that people will really love the designs!
Prof Tracey Howe appears in Decade of Healthy Ageing ‘Leaders Voices’ video alongside WHO and UN leadership
Professor Tracey Howe, Director of the Cochrane-Campbell Global Ageing Partnership and Co-Chair of the Cochrane Governing Board, has pledged support for the Decade of Healthy Ageing (2020-2030) in a video alongside António Guterres, UN Secretary-General; Dr Tedros Adhanom Ghebreyesus, WHO Director-General; Professor Klaus Schwab, Founder and Executive Chairman of the World Economic Forum; Dr Natalia Kanem, Executive Director United Nations Population Fund; the International Federation on Ageing; and HelpAge International.
The Decade of Healthy Ageing aims to bring together governments, civil society, international agencies, professionals, academia, the media, and the private sector to jointly take action in order to improve the lives of older people, their families, and the communities in which they live.
The Cochrane-Campbell Global Ageing Partnership has been actively supporting WHO in preparing for the Decade of Healthy Ageing, which is expected to formally launch via the United Nations in the coming months. We look forward to sharing the outputs of this collaboration in due course.
Supporting resilience and mental well-being in frontline healthcare professionals during and after a pandemic
What is the best way to support resilience and mental well-being in frontline healthcare professionals during and after a pandemic? What is ‘resilience’?
Working as a 'frontline' health or social care professional during a global disease pandemic, like COVID-19, can be very stressful. Over time, the negative effects of stress can lead to mental health problems such as depression and anxiety, which, in turn, may affect work, family and other social relationships. ‘Resilience’ is the ability to cope with the negative effects of stress and so avoid mental health problems and their wider effects. Healthcare providers can use various strategies (interventions) to support resilience and mental well-being in their frontline healthcare professionals. These could include work-based interventions, such as changing routines or improving equipment; or psychological support interventions, such as counselling.
What did the review authors want to find out?
Firstly, they wanted to know how successfully any interventions improved frontline health professionals’ resilience or mental well-being. Secondly, the authors wanted to know what made it easier (facilitators) or harder (barriers) to deliver these interventions.
The authors did not find any evidence that tells us about how well different strategies work at supporting the resilience and mental well-being of frontline workers. They found some limited evidence about things that might help successful delivery of interventions. Properly planned research studies to find out the best ways to support the resilience and mental well-being of health and social care workers are urgently required.
Lead author of this review Dr Alex Pollock explains, “It is clear that frontline healthcare workers have to deal with enormous stress when working in any infectious disease epidemic, and this clearly has a negative impact on their mental health. Despite this, there remains a lack of high quality research about how best to support the mental health of these workers. With the continuation of the COVID-19 pandemic there is an opportunity for carefully planned, well-conducted research to determine the best way to support the mental health of frontline workers - I really hope that these research studies are prioritised. While we found a lack of high quality research in this review, it is important to note that our focus was limited to evidence relating to healthcare professionals working during infectious disease epidemics / pandemics. It’s clear that we now need to expand the scope of this review and turn to evidence from other diseases and health crises. We also need to bring together evidence about how best to prepare people for frontline work. Finally, it’s important to remember that the majority of people who work at the frontline are not healthcare professionals, but are, for example, porters or cleaners. We need to make sure that future research addresses ways to support this wider workforce.”
What did the author team do?
They searched medical databases for any kind of study that investigated interventions designed to support resilience and mental well-being in healthcare professionals working at the front line during infectious disease outbreaks. The disease outbreaks had to be classified by the World Health Organization (WHO) as epidemics or pandemics and take place from the year 2002 onwards (the year before the severe acute respiratory syndrome (SARS) outbreak).
What did they find?
16 relevant studies were identified. These studies came from different disease outbreaks - two were from SARS; nine from Ebola; one from Middle East respiratory syndrome (MERS); and four from COVID-19. The studies mainly looked at workplace interventions that involved either psychological support (for example, counselling or seeing a psychologist) or work-based interventions (for example, giving training, or changing routines).
Objective 1: one study investigated how well an intervention worked. This study was carried out immediately after the Ebola outbreak, and investigated whether staff who were training to give other people (such as patients and their family members) 'psychological first aid' felt less ‘burnt out’. The authors had some concerns about the results that this study reported and about some of its methods. This means that confidence in the evidence is very low and the authors cannot say whether the intervention helped or not.
Objective 2: all 16 studies provided some evidence about barriers and facilitators to implement interventions. The author team found 17 main findings from these studies. They do not have high confidence in any of the findings and had moderate confidence in six findings and low to very low confidence in 11 findings.
The authors are moderately confident that the following two factors were barriers to implementation of an intervention: frontline workers, or the organisations in which they worked, not being fully aware of what they needed to support their mental well-being; and a lack of equipment, staff time or skills needed for an intervention. The authors are moderately confident that the following three factors were facilitators to implementation of an intervention: interventions that could be adapted for a local area; having effective communication, both formally within an organisation and informal or social networks; and having positive, safe and supportive learning environments for frontline healthcare professionals. The authors are moderately confident that the knowledge and beliefs that frontline healthcare professionals have about an intervention can either help or hinder implementation of the intervention.
Hours: Full time (37.00 hours per week - 1.0 FTE)
Basis: Fixed term contract for 12 months
Grade: I (£44045 - £51034)
Closing Date: 17th November 2020
Interview Date: 9th December 2020
The University of Central Lancashire - School of Medicine wishes to appoint a Managing Editor who will be based at UCLAN Preston campus but will be expected to work collaboratively with the wider study team internationally employing IT solutions to achieve this. This role will involve the primary managing editor role for the Cochrane Gut group satellite in UCLAN. The group has a portfolio of 120 reviews, 40 protocols and 25 titles at present. This covers IBD management in adults and children, excluding microbiome focussed works. Additionally, the children’s functional bowel portfolio. Through collaboration with the Cochrane Gut group in Canada, we will also lead editorial for all reviews authored by their editors and vice versa, involving work on a wider Gut portfolio.
There will be a significant volume of research output and scholarly content to be produced by the post holder themselves, as well as facilitating the wider team. Expect 30-40 full reviews per annum to be completing editorial as a minimum during this period of rapid updating and reprioritisation, as well as 20-30 protocols, associated positions pieces, editorials and patient / servicer user materials. The post holder will have to work highly efficiently, communicating in a timely and effective manner with the CEs and colleagues. There will also likely be educational and dissemination activities with various stakeholders and patients on a regular basis.
With experience of systematic review work and specific Cochrane experience, you will have knowledge and understanding of the work of Cochrane Collaboration and the nature of systematic reviews. Experience of Cochrane editorial roles and dissemination and presentation of such works is also essential.
You will have postgraduate training in an appropriate field to at least Masters level, including epidemiology, public health and medical specialities. A PhD or Professional Doctorate qualification are not essential requirements, but would be desirable.
You must possess excellent communication skills; have an ability to work within a multidisciplinary team and show initiative and innovation. With a professional and flexible approach, you will have a commitment to the missions and values of the University.
Informal enquiries are welcomed - please contact Morris Gordon, Head of Professionalism and Careers, via email in the first instance email@example.com.
Applicants need to meet all essential criteria on the person specification to be considered for interview. This position is based in Preston with travel required.
Please apply online via www.uclan.ac.uk/jobs or by contacting Human Resources on 01772 892324 and quoting the reference number. CVs will not be considered unless accompanied by a completed application form.
Tuesday, November 3, 2020 Category: Jobs
Cochrane Library Editorial: Prospective meta‐analyses and Cochrane's role in embracing next‐generation methodologies
An editorial was published on 30 October entitled "Prospective meta‐analyses and Cochrane's role in embracing next‐generation methodologies". Prospective meta-analysis (PMA) challenges the traditional approach to conducting a systematic review, including when and how the search is conducted and the role of trial authors, to minimise biases and maximise completeness and applicability. In the editorial, members of the Cochrane Prospective Meta-Analysis Methods Group describe the benefits of the approach and challenge Cochrane to find a balance in its systems and policies to accomodate next generation methods while maintaining quality and timeliness.
Today, a group of Iberoamerican medical and other health professions students have launched Estudiantes por la Mejor Evidencia (ExME), a Spanish-language blog that hopes to be an international hub for promoting, sharing, and disseminating information about evidence-based healthcare. This initiative, which follows in the footsteps of its English-language counterpart Students for Best Evidence (S4BE), is supported by Cochrane and Cochrane Iberoamerica and aligns with their Knowledge Translation strategies.
After more than a year of preparations, ExME has launched as a network of students interested in evidence-based health care and as a "community for students, by students". Its objective is to develop an interactive platform with the best, evidence-based training resources, thanks to the contributions of individual, Spanish-speaking students from around the world and the support of its collaborating institutions.
"We hope that ExME will be a place where we can discuss and debate -- through a process of continuous learning and constant innovation -- about the different concepts that are fundamental to the application of evidence-based practice," writes the inaugural blogpost by the members of the Coordinating Committee, which is led by Andrés Viteri, from UTE in Ecuador. They add, "We would also like for this to be a place to build community and connect with other students and working groups. So we hope that, through publications of reviews, interaction on social media, and the space for discussion that we are making available here, you can find many opportunities and projects."
For the launch of the blog, ExME has published four posts simultaneously, as well as the inaugural welcome post:
- Can electronic cigarettes help you quit smoking?
- Treatments can do harm
- Observational cohort studies: general concepts from biostatistics and clinical epidemiology
- The "Evidencias COVID-19" tool offers the best, one-click information about the pandemic in Spanish
These entries are the first posts in five sections that the blog will explore (Critical thinking, Fundamentals of evidence-based medicine, Clinical Practice, COVID-19, and Community for best evidence), which will be expanded over time.
If you are a Spanish speaker, join the ExME community!
Cochrane is preparing a series of reviews to help decision makers with their response to COVID-19. Each Cochrane podcast offers a short summary of a recent Cochrane COVID-19 review from the authors themselves. They allow everyone from healthcare professionals to patients and families to hear the latest Cochrane evidence in under five minutes.
Do blood thinners prevent people who are hospitalised with COVID-19 from developing blood clots?
In October 2020, we published the findings on the effects of anticoagulants and lead author, Ronald Flumignan from the Federal University of Sao Paulo in Brazil describes what they found in this podcast.
How effective is screening for COVID-19?
Screening programmes are in place for many conditions and the COVID-19 pandemic has led to discussions of whether people should be screened for SARS-CoV-2, which is the virus that causes COVID-19. A Cochrane rapid review from September 2020 looks at the evidence for universal screening and we asked lead author, Meera Viswanathan from RTI International in the USA to describe the findings in this podcast.
Is plasma from people who have recovered from COVID-19 an effective treatment for people with COVID-19?
In October 2020, we published our second update of the review of convalescent plasma and hyperimmune immunoglobulin and we asked its lead author, Khai Li Chai from Monash University in Australia, to tell us about the latest findings.
How accurate is chest imaging for diagnosing COVID-19?
We asked the lead author of the September 2020 review of the evidence on using imaging tests to diagnose the condition, Jean-Paul Salameh from The Ottawa Hospital Research Institute in Canada, to describe their findings in this podcast.
Does quarantine, alone or in combination with other public health measures, control coronavirus (COVID-19)?
In this podcast, lead author, Barbara Nussbaumer-Streit from Danube University Krems in Austria outlines the findings of the review of quarantine, which was originally requested by the World Health Organization and was first published in April, before being updated in September 2020.
Can travel-related control measures contain the spread of the COVID-19 pandemic?
In this podcast, lead author, Jake Burns from the University of Munich in Germany describes the findings of our review of the effects of travel-related control measures, which was published in September 2020.
Can symptoms and medical examination accurately diagnose COVID-19 disease?
Published in June 2020, this review examines the accuracy of using signs and symptoms to diagnose whether someone has the disease. We asked the lead author, Thomas Struyf from the KU Leuven in Belgium, to tell us why the review is needed and what they found.
Wednesday, November 4, 2020
This review aimed to gather evidence for the use of any physical activity intervention for people with congenital heart disease. The authors of this review aimed to compare interventions including exercise training, physical activity promotion or lung training with no intervention (usual care).
Congenital heart disease is the term used for a range of birth defects that affect how the heart works. People with congenital heart disease have reduced life expectancy, physical fitness and quality of life. However, due to better prenatal diagnoses, surgical procedures (often performed in the early years of life) and earlier interventions, the survival rate for those born with this disease has improved dramatically, such that most people will now live into adulthood. Exercise training and physical activity interventions are known to improve fitness, physical activity, survival and quality of life in healthy people, but it is not clear how effective these programmes are for people with long-term medical conditions.
The review authors searched for studies in September 2019 and identified 15 studies involving 924 participants. The studies used three main types of interventions, including programmes designed to increase physical activity, aerobic fitness and health-related quality of life and compared physical activity intervention and control interventions in people with congenital heart disease.
The authors included 15 trials with 924 participants. Half of the participants were female. Of the 15 trials, 5 used a total of 500 young people (less than 18 years of age) and 10 trials used a total of 424 adult participants. The review authors found that physical fitness and physical activity may slightly increase but we are very uncertain about quality of life. There is currently no data to say if this small increase in fitness will result in fewer visits to the hospital. But there were no recorded deaths or serious events that were related to participation in physical activity.
Quality of evidence
Using a validated scientific approach (GRADE), the certainty in the evidence base was moderate for fitness, low for physical activity and very low for quality of life. Most outcomes were limited due to small study participant numbers and poor reporting of study details.