Antidepressants are widely used for depression and anxiety. Guidelines recommend that an antidepressant should be continued for at least six months after people start to feel better, and for at least two years if they have had two or more periods of depression. Many people take antidepressants for much longer. Ellen Van Leeuwen and Mark Horowitz, authors of a recently published Cochrane review on approaches for discontinuing antidepressant use, answer some questions about the findings of the review.
Tell us about this Cochrane Review, why did you think it was important to do it?
Ellen: The rise in long-term antidepressant use is a major concern. For example, in the UK, nearly half of people using antidepressant (8% of the total population, approximately 3.7 million people) have been taking them for more than two years. Antidepressants that, despite initially being appropriate, are not discontinued after the recommended duration can lead to unnecessary harm and costs.
Mark: Antidepressants can put people at risk of adverse events such as sleep disturbance, weight gain, sexual dysfunction and gastrointestinal bleeding, as well as feeling emotionally numb and what they described as feeling “addicted,” because they cannot easily stop the medication. This is because people’s brains physically adapt to antidepressants after long-term use (called physical dependence). They may also impair patients’ autonomy to deal with problems in their life without medication. Guidelines recommend that antidepressants should be taken up to 6 to 12 months after improvement and 2 years after improvement in people at risk for relapse.
Ellen: As a GP I see many patients struggling with coming off antidepressants that they have been taking long-term. However, I was surprised that there wasn’t a Cochrane review on discontinuing long-term antidepressants, so I started this review. We included all studies comparing approaches for discontinuation with continuation of antidepressants (or usual care) for people who are prescribed antidepressants for depression or anxiety for at least six months.
What can people learn about discontinuation from antidepressants from this evidence?
Ellen: Honestly, the evidence in this area is very problematic. It is not possible to make any firm conclusions about the effects and safety of the approaches for discontinuation studied to date. There were only a few studies with a focus on successful antidepressant discontinuation rate.
The main problem is that studies did not distinguish between symptoms of relapse of depression and symptoms of withdrawal after discontinuation.
Mark: Yes, withdrawal symptoms can include insomnia, low mood, anxiety, changes to appetite, and these symptoms will be recorded on the depression scales used to detect relapse, so they might inflate the rate of relapse recorded in groups that stop antidepressants.
Additionally, most tapering regimes were limited to four weeks or less, in contrast to NICE guidelines recommending tapering over four weeks or more. In fact, there is now increasing recognition that antidepressants might need to be tapered over months or longer than a year to very low doses for long-term users.
Ellen: For me, it was disappointing that the large group of people taking antidepressants in the community (i.e. those with only one or no prior episode of depression) have been under-researched. Most published studies focus on people with recurrent depression. Another finding was that we found very low certainty evidence that high intensity psychotherapy such as mindfulness based cognitive therapy (MB-CT) and cognitive behavioural therapy (CBT) may support people to come off antidepressants. But none of the studies included more scalable and accessible psychological approaches such as online support.
And what can people learn about continuation of long-term antidepressant use?
Ellen: Based on the limitations we have mentioned, we cannot make any conclusion about this, as we were not confident in the evidence we found. We certainly need more de-prescribing studies investigating the harms and the benefits of discontinuation before we can make any conclusion.
Mark: Yes, it is very difficult to interpret existing studies that suggest continuation of antidepressants because they are based on discontinuation studies in which half of the patients are stopped – often abruptly or in a few days – compared to a group that continues their antidepressants. This means we can’t be sure whether the group who stopped got worse because of withdrawal symptoms or genuine relapse. To provide clearer evidence on this, future studies should distinguish carefully between relapse and withdrawal symptoms and follow emerging guidance to use taper schemes of many weeks or months (or longer for long-term users) down to very low doses before stopping. Such studies would give us a clearer idea of the ability of antidepressants to prevent relapse.
Ellen: Additionally, there is an urgent need to include wider representation of patient populations. For example, those people with one or no prior episodes of depression, those with anxiety disorders, and older people including those who take multiple medications (polypharmacy) and those who are frail. Most antidepressants are prescribed by GPs. This review reinforces the call for more research in the primary care setting, particularly for people with low risk of relapse and those for whom there is uncertainty about the benefit of antidepressant treatment.
What is the core message for clinician’s and patients?
Ellen: Overall there remain many uncertainties. However, this review aids clinicians in openly discussing with their patient and with family/carers (as appropriate) the potential benefits and harms of continuing or discontinuing antidepressants including withdrawal.
Mark: Doctors and patients should be aware that withdrawal symptoms from antidepressants are common and can be mistaken for relapse of the underlying condition. Although evidence found in this review is sparse, experiencing withdrawal symptoms is not a sign that the patient needs the antidepressant, but rather a sign that they might need to taper more gradually and down to lower doses before stopping.
What will happen next? Are you planning an update or any subsequent reviews on a linked topic?
Ellen: Celebrating with my team that we made it! No, I am currently working on a PhD of which the review is part of it which I want to defend in 2021. However, I’m continuing further research in the field of long-term antidepressants. One of the recommendations of our review is a further review comparing different discontinuation strategies.
Mark: At the moment there are a few studies happening around the world looking at discontinuing antidepressants, such as the REDUCE trial in the UK, some including somewhat slower tapers than the studies found in this review, going down to lower doses, and so an update to this review may be necessary in the future.
Dear Community Colleagues,
Last week, we informed you of the news that Mark Wilson was stepping down from his role as Chief Executive Officer (CEO) after eight years of outstanding service.
Today, we want to provide you with an update of the Governing Board's plans during this transition period for organizational leadership.
Our Editor in Chief, Karla Soares-Weiser, will be Cochrane’s Acting CEO; Toby Lasserson will be stepping up to Acting Editor in Chief; and Chris Champion, Head of People Services, will take on additional management responsibilities for finance, governance, and strategy. These arrangements will be effective until 24th May 2021.
Toby Lasserson, Karla Soares-Weiser, Chris Champion
We have begun the process of recruiting an interim CEO. More details on an appointment will follow shortly. In the meantime, the Board will work with Karla and the Senior Management Team to ensure continuity as the organization delivers its priorities for this year.
We understand that this is a time of change for Cochrane and we are committed to providing regular updates and information regarding our plans.
With our grateful thanks and best wishes,
Catherine Marshall and Tracey Howe
Co-Chairs on behalf of Cochrane’s Governing Board
- Visit an online Community Message-board where members, supporters and Group staff can leave their personal best wishes for Mark.
Closing date: 28 April 2021
Location: remote (home-working)
The Cochrane Pain, Palliative and Supportive Care (Cochrane PaPaS) Review Group is looking for an experienced Systematic Reviewer to undertake high quality, priority Cochrane systematic reviews for publication in the Cochrane Library.
The focus of PaPaS is studies of interventions for acute pain, chronic pain, headache and migraine, palliative care for those with life-limiting disease or illness, and supportive care of patients and significant others living with serious illness.
The candidate will work with a multidisciplinary team to undertake new priority reviews, or update existing reviews, often as lead author and Contact Person. The candidate will be expected to adhere to editorial procedures and timelines, liaise with co-authors and members of the CRG, and respond to peer review and editorial feedback. The candidate must also ensure all output meets Cochrane standards and expectations, for example the Cochrane Handbook for Systematic Reviews of Interventions, and Methodological Expectations of Cochrane Intervention Reviews (MECIR).
The ideal applicant will be educated with a first degree in a related field (e.g. medical sciences, biology, statistics) and will have a higher degree relevant to the research area or equivalent qualifications. The candidate will have an understanding and working knowledge of scientific and medical terminology and clinical trials methodology, experience in writing Cochrane systematic reviews, and the ability to interpret and communicate complex information.
The PaPaS CRG is funded by the National Institute of Health Research (NIHR) in the United Kingdom as part of the Research and Development programme, and hosted by the Oxford University Hospitals (OUH) NHS Foundation Trust.
Liverpool School of Tropical Medicine’s Centre for Evidence Synthesis in Global Health has led developments in systematic reviews in tropical medicine and international health. In the 1990s, staff contributed to setting up Cochrane, and established the Cochrane Infectious Diseases Group (CIDG). This is now recognised as one of Cochrane’s premier groups, with over 150 Cochrane reviews and 600 authors, and is well-linked with the World Health Organization.
Two job positions are currently being advertised with the Centre (Research Assistant and Clinical Research Associate in evidence synthesis). A further position is advertised with the University of Liverpool (Research Assistant/Postdoctoral Research Associate in medical statistics).
For informal inquiries regarding the two LSTM posts, please contact: email@example.com
- Full-time, fixed-term appointment for 1 year. Based in Liverpool
- Full details are available here: Research Assistant | LSTM (lstmed.ac.uk)
- Closing date: 28 April 2021
Based in Liverpool, an exciting opportunity has arisen for a Research Assistant to join the team of 11 staff to contribute to public health and clinical Cochrane reviews relevant to COVID-19. CIDG work closely with the Central Cochrane Editorial Unit in prioritising and completing relevant reviews. We have published reviews in public health measures including quarantine, diagnostic tests, and treatments. We are currently working with a variety of teams worldwide on COVID-19 relevant reviews and review updates, including diagnostic COVID-19 reviews with the international team organised from the University of Birmingham.
The successful candidate will have a Master degree that includes training in interpreting quantitative data; ideally you will also hold a postgraduate qualification in epidemiology or related quantitative topic. You will have experience in biomedical or social science research in low and middle-income countries, and have the ability to critically appraise medical literature at postgraduate level. A PhD is desirable.
You need clear evidence of critical insight into priority policy questions in international health relevant to infectious diseases, and experience in diagnostic test research is desirable. If you have authored a Cochrane review, have experience of using GRADE, or have a track record in published research, it will be an added advantage to your application.
Clinical Research Associate
- Full-time, fixed-term appointment for up to 18-months. Based in Liverpool
- Full details are available here: Research Associate | LSTM (lstmed.ac.uk)
- Closing date: 28 April 2021
Based in Liverpool, an exciting opportunity has arisen for a Research Associate to join the team of 11 staff to contribute to the broad programme of research and development in READ-It. We are currently working on Cochrane effects reviews in COVID-19, malaria drug treatment, malaria vector control and TB and malaria diagnostics; and a variety of qualitive evidence synthesis reviews in neglected tropical diseases and TB. There are also methodological projects related to Cochrane review methods that there may be opportunities to be part of. We aim for a mixed portfolio to provide a broad exposure to evidence-informed science.
The successful candidate will have an MBBS and an appropriate postgraduate qualification. You will have experience and confidence in critically appraising medical literature at postgraduate level and demonstrate evidence of a critical insight into priority policy questions in international health in infectious diseases relevant to low- and middle-income countries. Excellent skills in writing in plain English are important to the post.
The post holder will demonstrate experience of working in a multi-disciplinary team with the ability to work collaboratively as well as independently. We want people who have an enthusiastic approach to work and possess excellent attention to detail. Strong communication, time and organisational skills are pivotal as you will be responsible for ensuring effective communication flow within the project team. If you have authored a Cochrane review, have experience of using GRADE, have a track record in published research or possess a PhD in a relevant field, it will be an added advantage to your application. You will also contribute to the postgraduate teaching programme in critical appraisal and evidence synthesis.
Research Assistant / Postdoctoral Research Associate
University of Liverpool - Department of Health Data Sciences
- Full-time, fixed-term appointment for 1 year. Based in Liverpool
- Full details are available here: Research Assistant / Postdoctoral Research Associate (Grade 6/7) at University of Liverpool (jobs.ac.uk)
- Closing date: 16 April 2021
This is a post for a medical statistician with an interest in systematic reviews and network meta-analysis to support the work of the Liverpool Reviews and Implementation Group (LRiG), Cochrane Infectious Diseases Group and evidence synthesis research at the Department of Health Data Science.
You will have a Master’s degree in Statistics or a related field, an ability to manage quantitative data as well as advanced computing skills. Proven experience in the development and critical appraisal of indirect treatment comparisons and network meta-analysis is required and you will be able to use statistical software packages. You must be organised, conscientious and able to work both independently and within a research team.Thursday, April 8, 2021 Category: Jobs
Wednesday 7 April marks World Health Day, a day organised by the World Health Organization (WHO) to highlight a particular global health issue. This year, it aims to spotlight health equity.
Health equity is the absence of avoidable and unfair differences in health. The COVID-19 pandemic and its uneven impacts worldwide has brought attention to long-standing inequities in living and working conditions which affect people’s health outcomes.
This World Health Day, WHO is calling on leaders to address these inequities, to monitor them, and to ensure people have access to quality health care.
Cochrane is committed to promoting the consideration of health equity in evidence synthesis and has been working on this in several ways.
Health equity in the Cochrane Handbook
The Cochrane Handbook for Systematic Reviews of Interventions has a full chapter dedicated to incorporating health equity in evidence synthesis.
Health equity in methods
Equity has its own standard in the Methodological Expectations of Cochrane Intervention Reviews (MECIR), the overarching standards which guide the conduct and reporting of Cochrane Intervention Reviews. The Campbell and Cochrane Equity Methods Group is also developing an equity checklist.
Cochrane Interactive Learning health equity module
There is a module of the Cochrane Interactive Learning course on health equity in systematic reviews. In it, users can learn about health equity and how and when health equity can be incorporated in all steps of the systematic review process. The module also addresses how health equity should be considered in planning aspects of knowledge translation.
Cochrane Review Group Networks’ health equity priority setting
Cochrane Review Group Networks are currently piloting an approach to incorporating health equity considerations in priority setting for the update of reviews. Eve Tomlinson, Network Support Fellow for the Cochrane Cancer Network, presented an update on this project at last week’s monthly Join the Conversation webinar. Watch the recording below.
Vaccine equity declaration
In March 2021, Cochrane also signed WHO’s Vaccine Equity Declaration, which calls for a more equitable distribution of vaccines for COVID-19.
Cochrane community contributes to update to the PRISMA statement. PRISMA is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. PRISMA primarily focuses on the reporting of reviews evaluating the effects of interventions, but can also be used as a basis for reporting systematic reviews with objectives other than evaluating interventions (e.g. evaluating aetiology, prevalence, diagnosis or prognosis).
A dedicated global team of methodologists, search specialists, biostatisticians and systematic reviewers have spent the last few years diligently updating PRISMA - the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. First published in 2009, PRISMA was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found.
While this may sound simple, it is anything but. Systematic reviews are complex, using an array of methods from the identification of studies through to the synthesis of results, and careful reporting is required so that users of the review (such as guideline developers, policy makers, healthcare providers and patients) are able to understand what was done and how the findings might apply to them.
The updated open-access PRISMA statement is available online and published in no less than five leading journals - including BMJ, PLOS Medicine, Journal of Clinical Epidemiology, Systematic Reviews and International Journal of Surgery. It represents a major global collaborative effort which was sustained throughout the many challenging months dominated by COVID-19 throughout 2020. The project had strong representation from Monash University's School of Public Health and Preventive Medicine, with co-leads Matthew Page and Joanne McKenzie (and David Moher, Ottawa Hospital Research Institute) and contributors Sue Brennan and Steve McDonald. This representation reflects the calibre of systematic review expertise within the School - with specialisation in methods for bias, statistics, certainty of the evidence (GRADE) and searching.
PRISMA workshop participants, Cochrane Colloquium, Edinburgh 2018
‘This was such a rewarding experience thanks to the enthusiastic input, detailed deliberations and expert contributions from both our local team and fellow researchers around the world,’ lead author Matthew Page explains. ‘The updating process involved lengthy consultation and a comprehensive survey of systematic reviewers, journal editors and methodologists with experience with and interest in the use of the previous iterations of PRISMA.’
‘We obtained a lot of valuable feedback via our initial survey. In addition to answers to more straightforward multiple choice questions, we also collated over 100 pages worth of collective free text comments from respondents who felt really passionately about particular reporting elements, and specified what they thought should or shouldn’t be included in the updated guideline. We had this wealth of feedback to draw on and discuss at our two day workshop at the Cochrane Colloquium in Edinburgh back in 2018, which was fantastic. A healthy degree of consensus emerged from that, followed by much drafting, redrafting and careful considerations around the clarity of language used to update existing and outline new recommendations. This was followed up by piloting with authors to get their feedback and incorporate a final round of changes.’
Joanne McKenzie played a critical role throughout this process, co-facilitating the development meeting and processing the meeting notes, developing the updated guideline structure and overseeing the inclusion of guidance on new statistical developments that have been introduced in the decade since the original PRISMA statement was released.
‘We know systematic reviews are essential for healthcare providers, policy makers, and other decision makers, who would otherwise be confronted by an overwhelming amount of research to guide their decisions,’ Joanne says. ‘We really wanted to make this a practical, accessible and contemporary checklist both for systematic reviewers and for the many different users who depend on them. As such, we included detailed information about why reporting of each item is recommended along with plenty of examples from published reviews.’
‘We’re hopeful that these kinds of changes and additions to PRISMA 2020 will encourage greater uptake of the guideline and lead to more transparent, complete and accurate reporting of systematic reviews around the globe. There are plenty of positives in that for everyone.’
In a study Matthew Page and colleagues conducted on Reporting Characteristics of Systematic Reviews in PLOS Medicine back in 2016, around 29% of authors explicitly reported that they used the PRISMA Statement to guide either the conduct or reporting of their review, and all those who worked on this update are hopeful this number will continue to rise.
‘Looking ahead, we’ll continue to work together to plan and design interventions and software to help with future implementation,’ Joanne concludes. ‘We’re keen to evaluate both the use and usability of PRISMA 2020 in the months and years to come, so while we’re excited about the launch today it’s definitely part of a bigger picture plan to support and encourage more accurate and complete reporting of systematic reviews now and into the future.’
In March 2020, Cochrane Australia convened the National COVID-19 Clinical Evidence Taskforce - bringing together leading health researchers, experts and organisations from across the country.
Since then, over 240 members have worked around the clock to deliver living clinical guidelines and flowcharts for frontline health workers. The guidelines are updated and published online every week, they feature 124 guideline recommendations and have reached more than 180,000 users worldwide.
To learn more about the work of Cochrane Australia and how the Taskforce is continuing to evolve, click here to read a short case story.
Cochrane Austria, together with TranspariMED and Transparency International Austria, has recently published a report on clinical trial transparency in Austria, which provides an update on figures released one year ago.
The report uses data from the EU Trials Tracker to summarise the clinical drug trial reporting rates of the 14 largest sponsors in Austria. Under EU rules, clinical trial sponsors must post summary results to the EU Clinical Trials Register within one year of a study ending, or six months for paediatric trials.
According to the new report, results have now been published for 37% of due clinical trials, compared to just 18%, as cited in 2020.
While this is impressive progress – with some institutions making significant efforts to publish their backlog of results – there is still more work to be done. 233 completed and overdue trials are still awaiting results on the EU registry, and half of the sponsors have made no progress at all.
Barbara Nussbaumer-Streit, co-director of Cochrane Austria, said: “The trend towards better reporting is welcome. However, we should not forget that two thirds of trial results are still missing. This can lead to delays in the development of new and effective therapies, and thereby harms patients.”
Gerald Gartlehner, co-director of Cochrane Austria, said: "Missing clinical trial results can lead to patients receiving ineffective therapies because doctors lack important information."
Cochrane supports clinical trial transparency. We rely on the availability of trial results to produce high quality and relevant systematic reviews. When trial results are left unpublished, it is impossible to make truly evidence-informed decisions about healthcare and people can be put at risk.
Register for the 'A day with... Statistics Methods Group’ which is taking place on 11 May 2021.
This is part of a series of virtual events from Cochrane Training for anyone interested in systematic review methodology and the work of Cochrane Methods Groups. Whether you are new to systematic review methodology or an advanced-level learner, these virtual events will be an opportunity for you to meet and learn from colleagues from different Methods Groups, with a variety of online events happening throughout the day.
This all-day event will highlight the Cochrane Statistics Methods Group and methods and issues around heterogeneity. There will be presentations from early career researchers and a virtual 'get-to-know-you' networking session. You can register for a session on the latest methodological developments, pose a challenging methods question for one of our experts, explore some of the free learning that is available, or take part in Twitter chats using #adaywithCochraneSMG.
Celebrating Anne Anderson and Cochrane diversity with new designs: interview with artist Heather Tubwon
Interview with Heather Tubwon, the artist that created the new limited edition designs in the Cochrane store celebrating Anne Anderson and our diverse community.
The global Cochrane community are participating in a virtual walk and raising money for the annual Anne Anderson Award, which is given to a Cochrane member who has contributed meaningfully to the promotion of women as leaders and contributors to the organization. To mark this occasion, we have added limited editions designs to the Cochrane store, with sales going to the Anne Anderson Award. We caught up with the artist, Heather Tubwon, to learn more about her and new designs.
Hi Heather! Our Cochrane Community always finds it interesting to learn the backstory to things and learn more about people. Could you tell us a bit more about yourself?
Sure! I'm from the Midwest in the United States. I have a Bachelor of Fine Arts degree in Illustration from the Minneapolis College of Art and Design. I have a background in Graphic Design, Illustration, and Textile/Surface Design. Some of my favorite jobs have included creating artwork for toys, children’s clothes, and stationery products - and now for Cochrane!
Was art something you always were interested in?
Yes - When I was around 10, my classmates noticed some of my drawings and told me I was really good at it. That’s when I first considered art as a career. However, life had a lot of twists and turns for me, and I ended up working in the airline industry. One of my tasks in that role was writing, creating diagrams, and laying out an FAA approved manual to teach Flight Operations personnel new software. I really enjoyed this work, and thought I might enjoy being a Graphic Designer professionally. After taking some design classes in art school, I realized my real passion was illustration.
These designs were a bit different for us. They are centered around our Cochrane Community event, the Anne Anderson Walk. While we knew we wanted to incorporate our brand colours, we were looking for something playful. How would you describe your style?
I would describe my style as colorful, whimsical, and fun. I feel like I create my best work when I’m having fun, and I hope this joy comes across in my work. If I can make someone smile through my work, then I feel like I have accomplished my goal.
We launched the Anne Anderson Walk on International Woman's Day and are highlighting all the virtual walk pictures on a global map. Diversity is a core value to the Cochrane Community and one of our strengths too - so we really wanted celebrate that. Why do you think showing diversity is important in visual arts?
I think that showing diversity is important in visual arts. I am multiracial myself - my primarily ethnically is Ashkenazi Jewish and Black. There have been many times where I was not able to see other people that looked like me in media, especially as a child. Growing up, my local library only had two books showing biracial or multiracial families. This made me feel othered, or like I was different from everyone else. That’s why I always strive to show diversity in my own work. Cochrane shows diversity not only in it's member make-up but also in it's methods and the contributions people make - I created the design to represent that.
Anne Anderson is a beloved person in the Cochrane Community. Can you tell us a bit about working on that artwork?
After reading about Anne Anderson, I was impressed with all that she was able to accomplish in her short life. She seemed like a very ambitious and driven woman, someone who was a role model for many. I was honored to be asked to create a portrait of her. In creating her portrait, I wanted to be respectful and honor her legacy, while at the same time creating a work that was playful and engaging.
- See the limited edition Anne Anderson Walk designs in the Cochrane Store
- Visit Heather Tubwon's website
- Visit Heather Tubwon's Instagram account
Tuesday, April 6, 2021
Latest episode of the Dementia Researcher podcast chats about the work of Cochrane, how we support evidence-informed decision making in healthcare, our work on undertaking systematic reviews, and how you could become involved.
The Cochrane Dementia and Cognitive Improvement Group create reviews and methods guidance on all aspects of dementia, delirium and other cognitive disorders. Recent outputs have included a focus on diagnosis of dementia, which have been curated in to a Cochrane Library Special Collection, and reviews on prognosis and complex interventions.
The group Coordinating Editors are Dr Jenny McCleery and Dr Terry Quinn and they recently spoke with Dr Anna Volkmer and Adam Smith on the Dementia Researcher podcast. This biweekly podcast bring together panels of early career researchers and other dementia experts to discuss their research and career topics to support other early career researchers. The podcast covers research investigating Alzheimer's and other dementias, exploring prevention, diagnosis, treatments, care and how they're working to better understand the disease and the brain. For this session of the podcast they chatted about the work of Cochrane, how we support evidence-informed decision making in healthcare, our work on undertaking systematic reviews, and how you could become involved.
Terry (@DrTerryQuinn) is Senior Lecturer and Honorary Consultant in University of Glasgow. In addition to his Cochrane role, he works with the NIHR Complex Reviews Support Unit assisting author teams with evidence synthesis methods. Terry is passionate about increasing research capacity and supporting early career researchers and he hopes that the podcast will inspire enthusiastic researchers to get involved with Cochrane.
Jenny is a Consultant Psychiatrist in Oxford Health NHS Foundation Trust. Her work has involved older adults with dementia and their families for 25 years and her enthusiasm for Cochrane is driven by a wish to help provide accurate and accessible answers to the clinical questions important to her patients and colleagues.
- Visit the Cochrane Dementia and Cognitive Improvement Group website
- Listen to the podcast episode on Spotify or Apple Podcasts
- Visit the Dementia Researcher website
- Visit the citizen scientist platform, Cochrane Crowd
- Volunteer on the Cochrane TaskExchange platform
Monday, June 7, 2021
Lund University working paper illustrates how to integrate Cochrane Interactive Learning to deliver relevant evidence-based medicine learning objectives
In the Medical Degree Program at Lund University, Sweden, a new Scientific Scholarship theme has been implemented, including evidence-based medicine (EBM), as the application of scientific scholarship in EBM is a core aspect of medical education. Throughout the program, scientific scholarship and EBM are supported by multifaceted learning activities and structured assessment, ensuring that students work continuously and iteratively with these concepts. The theme also makes use of e-learning for written assignments and of Cochrane Interactive Learning modules together with locally developed e-lectures.
Lead author, Maria Björklund, Librarian at the Faculty of Medicine, reported “the Cochrane Interactive Learning modules cover the process of how to conduct a systematic review, from formulating a question to finding, assessing and summarising evidence from studies. Each module contains videos, quizzes and exercises and an assessment that generates a certificate. Students upload their certificates to the university’s learning management system as part of the formal course assessment. The modules’ contents are of high quality, the level is challenging and requires students to be engaged. The assessment tasks and modules can be revisited, which gives opportunity for repetition. The methodology of conducting a systematic review contains many elements that are necessary to master also for other evidence-based work relevant to students in their role as future physicians, such as clinical guideline development. Therefore, the Cochrane Interactive Learning modules were considered highly relevant to integrate in the Scientific Scholarship theme.”
She concluded, “our implementation of the Cochrane Interactive Learning modules where they match the learning objectives is successful, in line with previous findings. Together with locally developed e-lectures and specialized library support students get additional context and examples. Collaboration with an evidence expert organization, such as Cochrane, give students authentic and international context together with an understanding of the importance of systematic reviews in EBM. This has led to a significant increase in the number of students performing a systematic review as their master thesis.”
Tips from Lund University
- To help embedding the Cochrane interactive Learning modules in courses it’s good if the learning outcomes of the course match the Cochrane module.
- It will also help if you plan to use the Cochrane modules as part of the overall course assessment.
- If needed, the modules can be studied and used over several semesters.
- If students are new to systematic reviews, it’s good to give them context, perhaps with other locally developed learning activities explaining the methodology of systematic reviews.
- Invite people to collaborate in using Cochrane Interactive Learning - librarians, teachers, clinicians - to help students get many examples and situations where the Cochrane modules can be used.
Chris Watts, Cochrane’s Learning Manager added “It’s fantastic to see our Cochrane Interactive Learning modules used in this way. We have designed the suite of modules so that, as well as being used by individuals as standalone, self-directed learning, they can also be adopted by trainers to use as part of blended learning approaches. The modular design and clear learning outcomes for the modules helps trainers to select and integrate Cochrane Interactive Learning into their learning programmes. The work at Lund is an excellent example of that, and we’re keen to encourage others to do the same or share their experiences of doing so with us.”
Contact the Learning Team about using the Cochrane Interactive Learning modules as part of your blended learning training, via firstname.lastname@example.org
Learning progression from basic scientific scholarship to evidence-based medicine: a multimodal approach. Björklund, Maria; Perez, Maria Thereza; Regnér, Sara; Garwicz, Martin. Lund: Faculty of Medicine, Lund University, 2020. Research output : Working paper
The Addictive Brain is an online community aiming at bridging the gap between science and the world in general. Their audience is mostly non-scientists and students, so they communicate in simple language and avoid scientific jargons - making science and health evidence accessible!
They chatted about health evidence synthesis, it's importance and use, the "infodemic" we are currently facing, and how anyone can get involved in Cochrane. You'll learn a lot in 30 minutes!
Tiffany mentions lots of resources available to those new to Cochrane; here are some of the key links:
- Visit the Cochrane US website
- View the Evidence Essential training resource
- Learn about how to get involved in Cochrane
- Learn about the Infodemic
- Visit about the citizen scientist platform, Cochrane Crowd
- Volunteer on Cochrane TaskExchange
- Learn more about the Cochrane's Early Career Professionals Group upcoming activities
- Visit the Students 4 Best Evidence website
- Find training events and resources on Cochrane Training
- Visit the Addictive Brain website
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: Vanessa Young
Cochrane Cochrane Rehabilitation, Italy
How did you first learn about Cochrane?
I started referring to Cochrane as an undergraduate student to find reputable reviews for my research courses. Cochrane facilitated finding articles pertaining to the scope of my work as well as honing my critical thinking in a scientific but well-organized fashion that allowed me to seek out answers to the questions that I had. Most recently, I became attracted to their “plain language” section that I embraced in order to better develop my written and verbal communication skills with patients or people not familiar with the subject of neuropsychology.
What was your experience with Cochrane International Mobility?
My experience at Cochrane Rehabilitation was enlightening both personally and professionally. Highly regarded professionals like Dr. Chiara Arienti were willing to extend their trust, faith and confidence in my work despite navigating the complexities of a systematic review and the protocol process for the first time in a collaborative environment. It was a wonderful way to learn and grow as part of a distinguished team that inspired and motivated me through their assistance.
What are you doing now in relation to your Cochrane International Mobility Experience?
Currently, we’ve submitted the protocol for the PTSD interventions as they apply to the clinical rehabilitation process. We are in process of beginning the article screening and data extraction process culminating in the potential for publication and the distinct career building privilege to be listed as a co-author of the project.
Do you have any words of advice to anyone considering a Cochrane International Mobility Experience?
If you are a hardworking, eager to learn young researcher just beginning to build the knowledge, skills and experience base required to thrive, consider Cochrane. Cochrane provides unique accessibility and many windows of opportunity to interact with senior researchers on meaningful projects. The senior professionals patiently mentor their younger colleagues as worthy contributors deserving of their role on the team and provide priceless counsel. The main lesson is that science is a collaborative process requiring invested contributors and novel ideas that are not afraid to challenge the status quo.
Mindfulness has been growing in popularity across the globe over the past decade and is increasingly the subject of scientific research into the benefits it may deliver. In 2020, six students from Melbourne’s Monash University sought to better understand if and how mindfulness practice could help fellow medical students and junior doctors deal with the significant stresses and demands of their studies and chosen profession.
Alice Jiang, Gizem Hasimoglu, Jonathan Shachar, Qiao Xin Tee, Darren Trinh and Praba Sekhar signed up for the formidable task of completing a Cochrane systematic review of the latest evidence as part of the School of Public Health and Preventative Medicine’s Scholarly Intensive Placement (SIP) program. Cochrane Australia is based at Monash within the School of Public Health, giving the eager students direct access to all the right tools, support and supervisors.
‘We had all briefly looked at mindfulness during medical school,’ Praba explains. ‘So it was really interesting to be involved in a project that evaluated and assessed the effectiveness of mindfulness in a target population that I’m actually a part of. We know both from our first-hand experiences as students and from the extensive research that we conducted, that levels of psychological distress, depression and anxiety are consistently higher in medical students. Studies here in Australia found 48% of medical students to be psychologically distressed - that’s more than four times that of peers the same age. Junior doctors work longer hours (averaging 50 hours a week), and students report high expectations, competitiveness, frequent exams, heavy study loads and many time pressures as key contributing factors. Given mindfulness is now widely considered for beneficial and therapeutic uses, exploring how it might help stressed-out students and doctors as part of this placement program made a lot of sense.’
Supervised by Cochrane Australia’s Dr Tari Turner and Professor Sally Green, the students completed the SIP program and their Cochrane review using a unique relay-style approach - exploring both the evidence on mindfulness, and the challenges and rewards of conducting a systematic review.
‘All of our SIP participants proved themselves to be incredibly clever, creative and committed,’ Tari says. ‘Each student worked intensely for short periods of between six to nine weeks and passed the baton to the next person to progress the review. Collectively they covered everything from developing a protocol, to searching and selecting studies, collecting and analysing data, and understanding risk of bias, health economics and equity in systematic reviews. The result of this extraordinary effort is tangible. Mindfulness-based psychological interventions for improving mental well-being in medical students and junior doctors is now with Cochrane for peer-review and is expected to be published later this year. Sally and I are really impressed with and proud of all of our SIP students’ individual and collaborative achievements.’
The consensus among participants is similarly positive. ‘My work with Cochrane Australia gave me a wider appreciation for the time-intensive nature and thoroughness needed to carry out a Cochrane Systematic Review,’ Praba says. ‘I particularly enjoyed learning about specific technical skills required. Performing thorough data extraction and risk of bias was an invaluable experience. The skills I gained have enhanced my ability to make clinical judgement as a medical practitioner, and increased my ability to understand, scrutinise and evaluate medical advice and evidence.’
Fellow participant Darren Trinh couldn’t agree more and found the SIP program changed his perspective on many aspects of both research and researchers. ‘I had an image in my head that presented researchers as very competitive, very busy, scary people - probably akin to an evil lab scientist who had to compete for grants to put food on their table with no time for medical students who are thrust upon them,’ he quips. ‘Fortunately, this was the complete opposite of my experience and I thoroughly enjoyed interacting with researchers at Cochrane and internationally.’
‘The collaboration during the systematic review process offered an amazing insight that has changed the way I see systematic reviews. So many people work together, sharing an incredible amount of energy, resources and skill to create this single piece of evidence. It’s now clear to me why systematic reviews are seen as the peak of the evidence pyramid.’
- Visit the Cochrane Australia Website
Words: Shauna Hurley
Updated: 11 March 2021
Treating COVID-19 with tocilizumab (a medicine that blocks interleukin-6) reduces the numbers of people who die within 28 days of treatment, and probably results in fewer serious unwanted effects than placebo treatment.
Studies of other medicines that block interleukin-6 to treat COVID-19 are under way. The authors of this review will update this review when results from them become available.
COVID-19 is an infectious respiratory disease caused by a type of virus called a coronavirus. If the infection becomes severe, people may need intensive care and support in hospital, including machines to help them breathe (mechanical ventilation). Medicines that are currently used to treat other diseases are being tested in the search to find effective treatments for COVID-19.
Blocking interleukin 6
An immune response is how the body recognises and defends itself against harmful substances, such as viruses. COVID-19 can disrupt the immune system, causing it to over-react and produce dangerously high levels of inflammation. Interleukin-6 (IL-6) is a protein involved in triggering inflammation. Blocking the production of interleukin-6 could reduce inflammation and help the immune system to fight COVID-19.
Why did the authors do this Cochrane Review?
Tocilizumab and sarilumab are two medicines that block interleukin-6. They are used to treat other conditions that involve an "over-reactive" immune system, such as rheumatoid arthritis. We wanted to find out if medicines that block interleukin-6 can be used to treat COVID-19, and whether they might cause any unwanted effects.
What did the authors do?
They searched for studies that tested if medicines that block interleukin-6 could treat COVID-19.
They looked for randomised controlled studies, in which the treatments people received were decided by chance. This type of study usually gives the most reliable evidence about the effects of a treatment.
Search date: The authors searched for trials up to 26 February 2021.
What they found
The author team found 10 studies in 6896 people with COVID-19. The average age of people in the studies was 56 to 65 years, and 66% of the people enrolled were men. The studies took place in Brazil, China, France, Italy, the UK and the USA; four studies took place in more than one country. Three studies were funded by pharmaceutical companies.
The medicines tested were tocilizumab and sarilumab. Both medicines were compared against a placebo (a dummy treatment that appears identical to the medicine being tested but without any active medicine) or standard care. The results were measured 28 days after treatment and after 60 days or more.
The authors also found 41 more studies of medicines blocking interleukin-6 to treat COVID-19 that had not yet published any results. These included 20 studies of tocilizumab, 11 studies of sarilumab and 10 studies of other medicines. Some of those studies are still ongoing and we will update this review to include their results when published.
What are the main results of this review?
Compared with placebo treatment or standard treatment, treatment with tocilizumab:
- reduces the number of people who died, of any cause, after 28 days (evidence from 6363 people in 8 studies); on average, 32 fewer people per 1000 died when treated with tocilizumab plus standard care, compared with standard care alone or placebo;
- probably makes little or no difference to clinical improvement (which is leaving hospital or improvement in COVID-19 symptoms) at 28 days (evidence from 5585 people in 7 studies); and
- probably reduces slightly the number of serious unwanted effects, such as life-threatening conditions or death (evidence from 2312 people in 8 studies).
The authors are uncertain about the effects of tocilizumab treatment on:
- severity of COVID-19; that is, how many patients died of COVID-19 or needed a ventilator or additional organ support at 28 days (evidence from 712 people in 3 studies); or
- how many patients died, of any cause, after 60 days or more (evidence from 519 people in 2 studies).
No results were reported for tocilizumab after 60 days or more for improvement, or severity at 28 days of COVID-19.
The author team are uncertain about how sarilumab treatment affected the:
- numbers of people who died (of any cause) at 28 days (evidence from 880 people in 2 studies) and after 60 days (evidence from 420 people in 1 study); or
- the numbers of serious unwanted effects, such as life-threatening conditions or death (evidence from 880 people in 2 studies).
- Sarilumab probably does not cause more unwanted effects (of any type) than placebo treatment (evidence from 420 people in 1 study). No other results for sarilumab treatment were reported.
The authors were not able to explore which COVID-19 patients are more likely to benefit from this treatment.
Confidence in the results
The authors are confident that tocilizumab reduced the number of deaths (from any cause) at 28 days. Their confidence in the other results for tocilizumab is moderate to low; further evidence may change these results. Their confidence in the results for sarilumab is low; further evidence is likely to change these results. The authors' confidence was lowered because some of the studies did not report all their results.
Lead author Professor Isabelle Boutron explains, “In the rush to find effective treatments, good quality evidence is critical for health workers treating COVID-19 patients. We looked at this treatment because immunosuppressive effect of Interleukin 6 blocking agents might be valuable in patients with COVID-19 and found that it is a fast moving field. Some treatments, such as tocilizumab, seem beneficial on mortality at day 28 although more data are needed to identify which patients are more likely to benefit from the treatment. New data are available regularly therefore we plan to update this review when results become available."
Cochrane has signed a World Health Organization (WHO) Declaration that calls for a more equitable rollout of COVID-19 vaccines.
While several countries currently have vaccination programmes up and running, the global distribution of vaccines has so far been unequal. Many low- and middle-income countries are yet to receive any doses and face uncertainties about access.
The WHO Declaration highlights that quick and equitable rollout of vaccines will be key to avoiding future variants, saving lives, and ultimately ending the pandemic. It therefore calls on global, national and local leaders to reject vaccine nationalism and to prioritise the equitable distribution of vaccines in every country – focusing first on health workers and those at highest risk.
Wednesday, March 17, 2021
Cochrane firmly believes in the principle of equity and is proud to support this global initiative.
Read the full declaration here
Specifications: Part time 22.5 hours (Fixed term/Secondment/Consultancy role)
Salary: between £35,000 to £40,000 per annum full time equivalent
Application Closing Date: 5 April 2021
The Cochrane Methods Support Unit was created in 2019 to support the eight Cochrane Review Group (CRG) Networks in the efficient and timely production of high quality, high priority Cochrane systematic reviews. The MSU provides hands on statistical and methods support to Cochrane systematic reviews methods input on request by CRG Network editorial teams. The unit comprises two part-time Statistical Editors and one full time Systematic Review Methodology Editor.
As Statistical Editor, you will provide advanced research methods support and advice as requested by Network Editorial Teams (Network Senior Editor, Associate Editor or Network Support Fellow) or field queries from the Community Support Team as needed. The post holder will also provide independent methods review of high-profile reviews, including those intended for press release. In addition to this he or she will support the implementation of established and more complex methods in Cochrane reviews and work on monitoring the quality of statistical methods and analysis in Cochrane reviews to inform priorities for training and guidance. The role will require a formal qualification in epidemiology or biomedical statistics, and a good understanding of methods used in meta-analysis.
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. An understanding of Cochrane’s work and health research more generally is an advantage, but not essential.
The majority of Cochrane Central Executive staff are located in London, UK, however flexible location or a part-time appointment are possible for the right candidate.
How to apply
- For further information on the role and how to apply, please click here
- The deadline to receive your application is by 5 April 2021.
- 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.
- Interviews to be held on: w/c 26 April 2021