Irena Zakarija Grković, co-director of Cochrane Croatia, and Matko Marušić, head of quality assurance at Cochrane Croatia, both received awards from the city of Split.  

The Split City Council, on May 4, 2020, decided that the traditional awards of the city of Split should be given to two members of the Cochrane Croatia. The personal award was given to Irena Zakarija Grković, co-director of Cochrane Croatia, for selfless commitment and work on the popularization of breastfeeding. A second award was given to Matko Marušić, head of quality assurance at Cochrane Croatia, for the book "Mi Hrvati". 

Irena is a family medicine specialist and an internationally certified breastfeeding counsultant (IBCLC) and president of the Croatian association of IBCLC breastfeeding consultants (HUSD). She became a specialist in Melbourne, Australia, where she gained twelve years of clinical experience working with various groups of patients, especially people with special needs and Croatian-speaking emigrants. There she also became an internationaly certified breastfeeding consultant. Her areas of scientific, teaching and professional interest are breastfeeding and the protection of mothers and children, evidence-based medicine and education in basic clinical and communication skills, and she has published numerous scientific papers in these areas. She is a member and founder of the National commission for the protection and promotion of breastfeeding at the Croatian Ministry of Health, an educator in the UNICEF program "Baby-Friendly Maternity Hospital" and an assistant professor at the Department of Clinical Skills and co-head of Cochrane Croatia. 

Matko is one of the leading Croatian scientists, writer and professor emeritus of the University of Split. He graduated from the University of Zgreb, School of Medicine, where he graduated in 1970 with the Rector's award for Best student. Since 1971 he has been working as an assistant at the Department of Physiology of the School of Medicine in Zagreb, where he received his doctorate in 1976. He became a professor at the School of Medicine in 1980. He is the author of numerous works in the field of medical science as well as literary works. He described his childhood in the book "Snijeg u Splitu", which he dedicated to his eldest son Berislav. The book has been reprinted several times since 1987, and is also read as part of primary school reading. His second book, "Plaču li anđeli?" (1997) was dedicated to his son Stjepan Ljudevit. In that book, he described the horrors of the Croatian War of Independence and described the people who fought against and evil and superior enemy, and the victory of good people. Since he wrote books for his children, he also wrote the book "Škola plivanja" for his youngest daughter Maria Franka. In that book, which was published in 2005, she describes Marija’s growing up, narrating innocently and with parental love. In 2006, he published the book "Medicina iznutra", in which he spoke openly about various aspects of life in medical profession, including corruption. In 2019, he published the book "Mi Hrvati" as his long-term project made out of love for the Croatian people. As a professor at the School of Medicine in Zagreb, he was elected vice dean of regional medical studies in Split and Osijek in 1982 and is credited with founding today's School of Medicine in Split (1997), where he was dean from 2009 to 2010 and the School of Medicine in Osijek (1998). He also provided significant assistance in establishing the School of Medicine of the University of Mostar. In 1990, he started Croatian Medical Journal, which he edited and managed until 2011. He has published over 250 scientific papers, of which more than 190 in internationally indexed journals. His most internationally recognized scientific contribution is in the research of the thymus, and on immunology in bone marrow transplantation. 

We warmly congratulate Irena and Matko on the great recognition of the city of Split!

• Visit the Cochrane Croatia website 

Are psychological interventions effective and safe for adolescents with psychosis? Are there any differences in effect between different psychological interventions? New Cochrane systematic review looks at the available evidence. 

Psychosis is a mental illnesses characterised by alterations in thoughts and perceptions as delusions (false beliefs), hallucinations (seeing or hearing things that others do not see or hear) and can happen during adolescence. When this happens, the young person needs to see a mental health professional who will often prescribe medications. However, along with medications, adolescents with psychosis are likely to benefit from age‐appropriate psychological treatments (talking treatments) such as cognitive remediation therapy, psychoeducation, family therapy and group psychotherapy. These interventions can address social and psychological needs such as integration with peers and deal with the stigma and exclusion. We have reviewed the effects of these interventions for young people with psychosis using data from randomised controlled trials.

The Information Specialist of Cochrane Schizophrenia searched their trials register in May 2016 and March 2019 for trials that randomly allocated adolescents with psychosis to various treatment groups. The treatment groups could include either psychological interventions (with or without their usual treatment), medications alone, treatment‐as‐usual or other psychological interventions (with or without usual treatment).

This review includes only seven trials conducted in various parts of the world. The trials compared a variety of different psychological interventions with treatment‐as‐usual or with other types of psychological interventions, and they reported different outcome measures, making it difficult for us to compare one study with another. We were interested in the effect these treatments have on seven main outcomes: global state, mental state, adverse effects, cognitive functioning, global functioning, service use, and leaving the study early. None of the included studies reported adverse effect data.

Results

Absolute effect of psychological interventions (PIs, comparing PIs with treatment‐as‐usual (TAU))

Our analyses of reported data suggests that cognitive remediation therapy may help improve short term memory (a cognitive function) but treatment‐as‐usual may be better than CRT for improving mental state. Group therapy may be also be useful for improving global state. All other analyses for the main outcomes showed PIs had little or no effect compared to TAU.

Relative effects of PIs (comparing one type of PI with another type of PI)

Our analyses showed no real differences between the different types of PIs.

Conclusions

Some psychological interventions may have beneficial effects for selected outcomes but, overall, most results suggest little or no effect. However, all our results were based on data from a very small number of studies with small numbers of participants. We also have concerns with the methods used in these studies. Thus, there is considerable uncertainty about the reliability of these findings. We cannot make firm conclusions based on this evidence. Relevant well‐conducted randomised controlled trials are needed.

• Read the full systematic review
• Visit the Cochrane Schizophrenia  website

Cochrane invites expression of interest in joining our Conflict of Interest Panel. This independent panel  will work with Cochrane’s Research Integrity Team to arbitrate on potential breaches of the revised Cochrane Conflict of Interest Policy for Cochrane Library Content and provide general guidance on how the policy should be applied. The panel will be take up it’s duties when the revised policy is launched in October 2020.

The panel will work on a voluntary basis and have a maximum of four persons and will be appointed by the Editor in Chief (EIC) in consultation with the Senior Research Integrity Editor. The panel members will select a chair from among the membership of the panel.  The Chair will be the main contact person for the panel, will convene virtual or face-to-face meetings of the panel, and consult with the panel as needed.

Responsibilities
The duties of the panel are as follow: 

• Review cases and make decisions on individual cases referred according to specified time frames.
• Respond to queries about the COI policy generally
• Comment on revisions of the COI policy
• Provide advice when the Editorial & Methods Dept conducts an audit of compliance to the policy
• Prepare an annual report of Panel activity for the EiC
• Participate in training activities that support those creating Cochrane Library content to adhere to the policy
• Assist in the development of supporting materials (e.g. FAQs)

Qualifications
Applicants must have no financial conflicts of  interest. In addition the following knowledge and/or experience are desirable:

• Experience serving on or chairing a COI committee or its equivalent (or similar committees. such as academic-industry relations committees)
• Experience with drafting and / or implementing conflict of interest policies (ideally related to research or health policies, such as guidelines)
• Familiarity with the literature on identifying, managing and impact of conflicts of interest in health
• Familiarity with journal policies related to conflicts of interest
• Experience as a Cochrane member or knowledge of  Cochrane 

Time commitment
Variable, estimated at 3-4 hours per month, which includes attendance at meetings as necessary.

Duration of term
The term of the Panel members is two years, with the possibility of another two-year term, to a maximum of four years. 

Support
Administrative support and co-ordination will be provided by the Research Integrity Team, in the Editorial & Methods Department.

Submissions & closing date
Any questions about panel membership and expressions of interest (in the form of a brief cover letter) should be submitted to COIarbiter@cochrane.org

Deadline for expressions of interest: July 31st, 2020

The work of healthcare professionals (e.g. nurses, physicians, psychologists, social workers) can be very stressful. They often carry a lot of responsibility and are required to work under pressure. This can adversely affect their physical and mental health. Interventions to protect them against such stresses are known as resilience interventions. Previous systematic reviews suggest that resilience interventions can help workers cope with stress and protect them against adverse consequences for their physical and mental health.

Cochrane review authors asked, “do psychological interventions designed to foster resilience improve resilience, mental health and other factors associated with resilience in healthcare professionals?” This question is particularly relevant at the moment, when healthcare workers are under great pressure due to COVID-19.

Review authors searched for studies up to June 2019. They found 44 studies that tested a range of resilience interventions. Thirty-nine studies included healthcare professionals only (6892 participants). Four studies included healthcare professionals and non‐healthcare workers (1000 participants). The remaining study examined 82 volunteer emergency workers.

Nineteen studies compared a combined resilience intervention (e.g. mindfulness and cognitive‐behavioural therapy) with unspecific comparators (e.g. a wait‐list control). Most interventions were performed in face-to-face, in groups, with high training intensity of more than 12 hours or sessions.

The review authors found very low-certainty evidence that resilience training may improve resilience in healthcare professionals, and may reduce symptoms of depression and stress immediately after the end of treatment. Resilience interventions do not appear to reduce anxiety symptoms or improve well‐being. Very few studies reported on the longer‐term impact of resilience interventions. Only three studies examined potential adverse events and found no undesired effects.

Studies used a variety of different outcome measures and intervention designs, making it difficult for the review authors to draw general conclusions from the findings. The evidence that they found in this review is limited and very uncertain. This means that, at present, the review authors have very little confidence that resilience interventions make a difference to healthcare workers’ resilience.

The review authors will include results of an updated search of four key databases carried out in June 2020 when they update their review.

• Read the full review here

A new systematic review from Cochrane Infectious Diseases Group  published today; 'Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease'.

COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. Most people with COVID-19 have a mild to moderate respiratory illness; others experience severe illness, such as COVID-19 pneumonia. Formal diagnosis requires laboratory analysis of nose and throat samples, or imaging tests like CT scans. However, the first and most accessible diagnostic information is from symptoms and signs from clinical examination. If initial diagnosis by symptoms and signs were accurate, the need for time-consuming, specialist diagnostic tests would be reduced.

Symptoms are experienced by patients. People with mild COVID-19 might experience cough, sore throat, high temperature, diarrhoea, headache, muscle or joint pain, fatigue, and loss of sense of smell and taste. Symptoms of COVID-19 pneumonia include breathlessness, loss of appetite, confusion, pain or pressure in the chest, and high temperature (above 38 °C).

Signs are evaluated by clinical examination, and include lung sounds, blood pressure and heart rate.

Often, people with mild symptoms visit their doctor (primary care physician) for an initial diagnosis. People with more severe symptoms might visit a hospital outpatient or emergency department. Depending on their symptoms and signs, patients may be sent home to isolate, may receive further tests or be hospitalised.

Why is accurate diagnosis important?
Accurate diagnosis ensures that people receive the correct treatment quickly; are not tested, treated or isolated unnecessarily; and do not risk spreading COVID-19. This is important for individuals and saves time and resources.

We wanted to know how accurate diagnosis of COVID-19 and COVID-19 pneumonia is in a primary care or hospital setting, based on symptoms and signs from medical examination.

What did we do?
We searched for studies that assessed the accuracy of symptoms and signs to diagnose mild COVID-19 and COVID-19 pneumonia. Studies could include people with possible COVID-19, or people known to have – and not to have – COVID-19. Studies had to be in primary care or hospital outpatient settings only and include at least 10 participants with any symptom or sign that might be COVID-19.

The included studies
We found 16 relevant studies with 7706 participants. The studies assessed 27 separate signs and symptoms, but none assessed combinations of signs and symptoms. Seven were set in hospital outpatient clinics (2172 participants), four in emergency departments (1401 participants), but none in primary care settings. No studies included children, and only one focused on older adults. All the studies confirmed COVID-19 diagnosis by the most accurate tests available.

The review authors searched for studies published from January to April 2020.

Main results
The studies did not clearly distinguish mild to moderate COVID-19 from COVID-19 pneumonia, so we present the results for both conditions together.

The results indicate that at least half of participants with COVID-19 disease had a cough, sore throat, high temperature, muscle or joint pain, fatigue, or headache. However, cough and sore throat were also common in people without COVID-19, so these symptoms alone are less helpful for diagnosing COVID-19. High temperature, muscle or joint pain, fatigue, and headache substantially increase the likelihood of COVID-19 disease when they are present.

How reliable are the results?
The accuracy of individual symptoms and signs varied widely across studies. Moreover, the studies selected participants in a way that meant the accuracy of tests based on symptoms and signs may be uncertain.

Conclusions
All studies were conducted in hospital outpatient settings, so the results are not representative of primary care settings. The results do not apply to children or older adults specifically, and do not clearly differentiate between milder COVID-19 disease and COVID-19 pneumonia.

The results suggest that a single symptom or sign included in this review cannot accurately diagnose COVID-19. Doctors base diagnosis on multiple symptoms and signs, but the studies did not reflect this aspect of clinical practice.

Further research is needed to investigate combinations of symptoms and signs; symptoms that are likely to be more specific, such as loss of sense of smell; and testing unselected populations, in primary care settings and in children and older adults.

• Read the full systematic review
•  Visit the Cochrane Infectious Diseases Group website 
• What are diagnostic test accuracy reviews?
• What is the difference between a Cochrane systematic review of interventions and a Cochrane diagnostic test accuracy review?
• Read all the Cochrane resources and news on COVID-19

Cochrane is proud to recognize participants and collaborators from its global community who have been part of its first Knowledge Translation virtual mentoring programme. 

Twelve pairs of mentors and mentees took part in the pilot, coordinated by Cochrane’s Knowledge Translation (KT) Department, between September 2019 and March 2020,  with the aim of developing skills, as well as passing on expertise, in knowledge translation. 

We were delighted to receive huge interest in the scheme with 38 members of the Cochrane community applying to be mentees and 25 people from within and outside of Cochrane volunteering to act as KT mentors. 

Mentors and mentees were matched, received online training and guidance, and then met together over six months to work on their projects. You can read a full summary of the KT Mentoring programme  here as well as finding out what happens next with this programme. 

We wish to pass on a huge thank you to all our KT mentors and mentees for their hard work and commitment. Here are a few of their stories:

Eve Tomlinson, Network Support Fellow for the Cochrane Cancer Network, has been a mentee in the KT mentorship programme. She worked on a project to map stakeholders for Cochrane Review Groups and the Network overall, with the ultimate goal of facilitating stakeholder engagement in review production and knowledge translation activities in the Network. She says of her decision to undertake this project with the KT mentoring program, “I applied for mentoring in the hope that I would receive guidance from someone with relevant experience to help me deliver the project and ensure it was useful for Cancer CRGs. As someone who enjoys KT, I was also keen to have a fellow KT-enthusiast to speak to about KT within Cochrane!” From the successful completion of this project, Eve worked within the CRG to identify 180 stakeholders working toward common goals in cancer research, and she is working with some cancer CRGs on stakeholder engagement. She wrote a guest blog for Cochrane about this project; read it here. 

Michael McEvoy applied for the mentorship program as a dissemination fellow for the Cochrane Anaesthesia Review Group (CARG). Working with his mentor, he undertook to increase engagement with reviews from CARG, combining “background” dissemination (such as writing summaries of reviews for newsletters, social media etc) with big projects (such as promoting reviews to authors of national guidelines). He is most proud of the Regional Anaesthesia Special Collection that he helped create as part of this mentoring program, which became highly relevant during the COVID-19 pandemic and generated significant interest and was widely read. Of the mentoring experience, he says, “It was incredibly useful and the project would not have been as successful without it. The mentoring applies some pressure to make sure you progress with your project without it being challenging or critical. It helped me feel more integrated into Cochrane and meet someone from a different group and it encouraged me to think about how I could continue to work more with Cochrane in the future.” 

In summary, participants spoke passionately about how they found virtual mentoring hugely valuable for their own learning and would like to see the programme repeated and more opportunities for developing KT skills in the future. Two-thirds of mentees reported feeling more confident about understanding and applying KT practices in their work, and mentors spoke about feeling valued and developing their own thinking and ideas as a result of having a new challenge. 

Recognizing the success of this first programme, Cochrane will form a second cohort of mentoring pairs, and seek applications for participants from September 2020.

Learn more about the pilot programme

Find out more about Knowledge Translation in Cochrane

Knowledge Translation Department 

Interview with Kelsey Hegarty, Professor Family Violence Prevention, The University of Melbourne and The Royal Women's Hospital and lead author of this Cochrane Review.

Tell us about this Cochrane review…
Domestic violence (physical, emotional, sexual abuse and controlling behaviour by a partner or ex‐partner) is common worldwide and causes long‐lasting emotional and physical health problems. Psychological therapies (counselling by trained people) may improve women's mental health and enable them to focus on making safety plans, accessing resources for themselves and their children, and ultimately to escape the domestic violence.

We searched scientific literature worldwide up to the end of October 2019 for trials comparing a group of female domestic violence survivors who received psychological therapy with those who did not, to understand whether such therapies are safe and effective.

What did you find out?
We found evidence that psychological therapies probably reduce depression and may reduce anxiety symptoms for women who have experienced domestic violence (six to 12 months after the therapy). Psychological therapies do not appear to cause any harm. However, we are uncertain whether psychological therapies improve self‐efficacy, mental health, quality of life, social support, uptake of healthcare and domestic violence services, safety planning or reduce post‐traumatic stress disorder and re‐exposure to any form of domestic violence.

Overall, there is a need for more trials with consistent outcomes at similar follow‐up time points as we were unable to combine much of the research to give an overall picture.

Thus, while women experiencing domestic violence may be helped by psychological therapies to improve their emotional health, which may in turn help their ongoing needs of safety, support and holistic healing from complex trauma, we are uncertain whether psychological therapies improve these aspects of their live

During the COVID-19 pandemic and resulting movement restrictions an upsurge in domestic violence has been reported. What can this review tell us about treatment for women who have experienced intimate partner violence during this time?
Access to help is a real issue during the COVID pandemic for both domestic violence and mental health issues. This review tells us that psychological therapies are likely to improve depression and anxiety symptoms. Some of these therapies are being offered online or through telehealth during COVID so may assist women experiencing IPV. However, their partner may be monitoring their use of technology and it may not be safe for them to receive this help.

Given the world-wide rise in violence against women during the pandemic, how can this review help decision makers facing decisions about where to invest resources? And help clinicians decide the best course of action?
This review reassures decision makers that psychological therapies help women with their emotional health, however currently there is no evidence that it assists with safety issues or healing in a broader sense. Therefore, investment in resources that address these issues as an integrated package would be helpful. Clinicians should be aware of ensuring they know how to address safety in addition to offering therapy.

How can this review help women who have experienced intimate partner violence who want to seek out help?
Women who feel as if their emotional health is something that they want help with can be reassured that in the context of IPV psychological therapies may assist them to feel better. This in turn may help them to take action on a pathway to safety and healing. However, more research is needed as there were limited studies to draw on.

• Read the review
• Learn more about the Cochrane Common Mental Disorders Group
  
   

Cochrane's strength is in its collaborative, global community.  Our 82,000 members and supporters from more than 130 countries work together to produce credible, accessible health information and help inform health decision making. Though we are spread out across the globe, our shared passion for health evidence unites us. 

We want to come together and tell our collective and individual Cochrane stories! To share your #MyCochraneStory please contact  Rachel Klabunde - rklabunde@cochrane.org - with the following:

• A photo: At your desk, at Cochrane event, something beyond a headshot.
• Your country of residence: Are community is diverse and we want to celebrate this!
• Your Cochrane Story: We want to hear about  what Cochrane work and achievements you are most proud of! 3-4 sentences about yourself and your story and any URLs that could be included.

Rachel Klabunde, from Chile, joined Cochrane in 2019 helping the Cochrane Chile team to plan the 2019 Cochrane Colloquium in Santiago. She now work as part of the Community Support team in People Services and as a Communication Officer in the Knowledge Translation Department of the Cochrane Central Executive Team. Due to widespread violence and civil unrest in Santiago, the annual Colloquium gala dinner was canceled. Our annual event would have featured a four-day wide-reaching scientific programme entitled ‘Embracing Diversity’ as well as a Gala Dinner open to all delegates. Due to the cancellation, all the pre-ordered food including catering provisions for a three-course Gala dinner was donated to a local charity in Santiago. Turning this negative moment into something positive is definitely something to be proud of!

Muriah Umoquit, from Canada, joined Cochrane in 2015. Working in the Knowledge Translation Department of the Central Executive Team, she  is a self-proclaimed 'Cochrane Fangirl'. Knowing how daunting rows of academic posters can be, she was thrilled to work on a project bringing branded #BetterPoster templates to disseminate Cochrane work at Colloquiums and other academic conferences.  You can view many of these posters from our virtual 2019 Colloquium - including hers!

We want to come together and tell our collective and individual Cochrane stories! To share your #MyCochraneStory please contact  Rachel Klabunde - rklabunde@cochrane.org - with the following:

• A photo: At your desk, at Cochrane event, something beyond a headshot.
• Your country of residence: Are community is diverse and we want to celebrate this!
• Your Cochrane Story: We want to hear about  what Cochrane work and achievements you are most proud of! 3-4 sentences about yourself and your story and any URLs that could be included.

Members of Vivli, the Center for Clinical Research Data, have announced their commitment to share their COVID-19 trials through Vivli. Members who have committed to sharing their data on the COVID-19 portal, a dedicated search function within Vivli for COVID-19 include Eli Lilly & Company, Regeneron, Roche, Takeda. 

Cochrane has previously partnered with Vivli by helping to provide vocabulary for the search platform and has expressed support of these efforts toward sharing COVID-19 data.

“Coronavirus is currently the most searched term on the Vivli platform and the new search experience is coupled with an accelerated process for data sharing. We believe that now, more than ever, sharing the individual participant data that underpins trial results is vital to driving forward both new science as well as scientific consensus,” said Rebecca Li, Vivli Executive Director.

“Vivli will continue to waive the fees for sharing for any interventional trial related to COVID-19 and to make the process as easy as possible. You don’t have to be a member to share your data using Vivli. We can and do share data from researchers from industry, academia, and non-profits. We have also partnered with vendors who can anonymize these datasets who have offered to anonymize the datasets waiving their normal fees. Vivli is doing all it can as part of the wider ecosystem of the health research community who are collaborating and coming together to do everything we can to find a treatment or vaccine for COVID-19.”

Vivli provides researchers with a secure, easy-to-use online platform to archive and share clinical trial data across all diseases and research entities. Vivli also allows researchers to combine and analyze data from multiple trials using state of the art tools.

Editor in Chief of the Cochrane Library, Karla Soares-Weiser said, “The pandemic represents a significant threat to global health, high quality evidence to inform decision making is needed urgently. Now, more than ever, fast, shared access to trial data is needed. Cochrane is pleased to support this initiative from Vivli as it promotes research integrity, transparency and acknowledges the value of timely and responsive production of evidence.”

About Vivli

Vivli is a non-profit organization working to advance human health through the insights and discoveries gained by sharing and analyzing data. It is home to an independent global data-sharing and analytics platform which serves all elements of the international research community. The platform includes a data repository, in-depth search engine and cloud-based analytics, and harmonizes governance, policy and processes to make sharing data easier. Vivli acts as a neutral broker between data contributor and data user and the wider data sharing community. For more information, visit www.vivli.org and follow us on Twitter @VivliCenter.

Today Cochrane, a global independent organization that reviews evidence from research to inform health decision-making, publishes a review of studies looking at the accuracy of COVID-19 antibody tests. 

The review shows that antibody tests could have a useful role in detecting if someone has had COVID-19, but that timing is important. The tests were better at detecting COVID-19 in people two or more weeks after their symptoms started, but we do not know how well they work more than five weeks after symptoms started. We do not know if this is true for people who have milder disease or no symptoms, because the studies in the review were mainly done in people who were in hospital. In time, we will learn whether having previously had COVID-19 provides individuals with immunity to future infection.

Antibody tests are an important public health tool to identify individuals with previous COVID-19 disease. This enables assessment of the spread of infection and the need for public health interventions.  The review summarizes research evidence available up until the end of April 2020 to see whether antibody tests: 

• are accurate enough to diagnose disease in people with or without symptoms of COVID-19, and 
• can be used to find out if someone has already had COVID-19.

The immune system of people who have COVID-19 responds by developing proteins in the blood called antibodies that attack the virus. Detecting antibodies in people’s blood may indicate whether they currently have COVID-19 or have had it previously.  Whilst detecting current infection is usually done using swab tests within the first 5 days of illness, they may miss infection and are not available to all.  

Cochrane researchers from universities across the world led by experts from the University of Birmingham searched through the 11,000 publications on COVID-19 available at the end of April to find studies that reported results of antibody tests in groups of people known to have (or have had) COVID-19 and others known not to have had COVID-19 based. They found a total of 54 relevant studies reporting test results for nearly 16,000 samples. The majority of studies were from China and were carried out in people who had been admitted to hospital and likely to have had severe disease. 

The studies looked at three types of antibody, IgA, IgG and IgM. Most tests measured both IgG and IgM, but some measured a single antibody or combinations of the three antibodies. Data were only available for 27 tests, a small fraction of the over 200 tests on the market. Data were available on both laboratory based tests, which require blood samples taken from the veins, and point-of-care tests, which can use finger-prick blood samples. There were not enough data to compare the accuracy of different tests. The authors will continue to update this review over the next few months to provide a more complete summary of the research evidence as it accumulates.

The researchers found that the sensitivity (the proportion of the people who have had COVID-19 that the test can detect) of antibody testing is very closely related to when the test is performed. Tests of the IgG and IgM antibodies at 8 to 14 days after onset of symptoms correctly identified only 70% of people who had COVID-19. However, when the researchers looked at data reported at between 15 and 35 days after symptoms first began, antibody tests accurately detected over 90% of people with COVID-19. There are insufficient studies to estimate the sensitivity of antibody tests beyond 35 days after the beginning of symptoms.  The tests only wrongly diagnosed COVID-19 in 1% to 2% of people without COVID-19.

To illustrate what these accuracy figures mean, in a sample of 1000 people where 200 people (20%) really have COVID-19, typical of workers in a hospital setting where COVID-19 patients have been treated:

• 193 people would receive a positive test result but 10 (5%) of those people would not have COVID-19 (known as a false positive result);
• 807 people would receive a negative test result but 17 (2%) of those people would have COVID-19 (known as false negative result).

In a population where COVID-19 was more common there would be more false negatives and fewer false positives.

Studies showed that antibody tests may have a role in diagnosing COVID-19 in patients who have had COVID-19 symptoms for two or more weeks but who have not had a swab (PCR) test or tested negative despite COVID-19-like symptoms.

Professor Jon Deeks, Professor of Biostatistics and head of the Test Evaluation Research Group at the University of Birmingham, explains: “We’ve analyzed all available data from around the globe - discovering clear patterns telling us that timing is vital in using these tests. Use them at the wrong time and they don’t work. While these first COVID-19 antibody tests show potential, particularly when used two or three weeks after the onset of symptoms, the data are nearly all from hospitalized patients, so we don’t really know how accurately they identify COVID-19 in people with mild or no symptoms, or tested more than five weeks after symptoms started.

The researchers also had several concerns about the quality of the studies they found. Studies were small and did not report their results fully. Many papers included multiple samples from the same patients. More than half of the studies were made available before they had been through peer review (publications known as ‘preprints’). In one important UK study the biomarker manufacturers did not approve the identification of the tests that had been evaluated.

Dr Jac Dinnes, who worked on the review with the University of Birmingham team commented, “The design, execution and reporting of studies of the accuracy of COVID-19 tests requires considerable improvement. Studies must report data broken down by time since onset of symptoms. Action is needed to ensure that all results of test evaluations are available in the public domain to prevent selective reporting. This is a fast-moving field and we plan to update this review regularly as more studies are published.” 

• Read the full Cochrane Review
• Visit the Cochrane Infectious Diseases Group website
• What are diagnostic test accuracy reviews?
• What is the difference between a Cochrane systematic review of interventions and a Cochrane diagnostic test accuracy review?
• Use the Interactive COVID diagnostic test calculators (based on Woloshin, et al., NEJM, 2020)

Cochrane systematic reviews of interventions (intervention reviews) and Cochrane diagnostic test accuracy reviews (DTA reviews) are two types of systematic review.

They share the following characteristics:

• They aim to answer a specific healthcare question to help people make decisions based on up-to-date evidence from research. 
• They look for all the relevant studies to answer the review question.
• They appraise the reliability of the studies.
• They summarize the results to produce a picture of the body of evidence available. 
• They are systematic because they search for and analyze evidence in a systematic way, according to predetermined and published methods.

Intervention reviews

Intervention reviews seek to answer questions about the effectiveness of healthcare interventions (medicines, treatments or policies) on the people who receive them. For example: ‘How effective is acupuncture for treating depression’; or ‘Which treatment is most effective for treating psoriasis?’. To answer such questions, the authors of intervention reviews identify studies that compare one intervention with either another intervention, an inactive intervention (placebo), or no intervention. Depending on the number and reliability of the studies identified, intervention reviews may provide information on whether the intervention works, or whether we need more evidence before we can draw a conclusion. They may identify for whom the intervention works best, which version of the treatment works best, whether another option is just as effective, and whether it causes any unwanted effects. 

DTA reviews

DTA reviews evaluate how well diagnostic tests (index tests) identify or exclude a particular disease or condition (the target condition). We know that diagnostic tests make errors, even when they are correctly performed. There are two types of test errors: false positive test errors (the index test suggests the target condition is present when it is not) and false negative test errors (the test suggests the target condition is absent when it is not). Cochrane DTA reviews can cover all types of diagnostic tests, from antibody tests to X-rays, for any disease or condition. It is really important that diagnostic tests provide accurate results so that people can receive prompt treatment or take preventive measures if necessary, and to avoid unnecessary testing, treatment and anxiety

DTA reviews combine the results of all available test accuracy studies to determine the best possible estimate of the accuracy of an index test. Test accuracy studies most often report accuracy using sensitivity and specificity. 

Sensitivity means the proportion of people who are correctly diagnosed by the index test. Specificity means the proportion of people without the target condition who are correctly identified by the index test. Therefore, the nearer the sensitivity and specificity are to 100%, the better the test.

An alternative way to report test accuracy is using positive and negative predictive values, which tell us about the usefulness of a positive index test result and a negative index test respectively – this helps patients understand how reliable their test results are. Predictive values measure the number of positive index test results that will be true positives and the number of negative index test results that will be true negatives. The nearer the positive and negative predictive values are to 100%, the better the test. 

Cochrane DTA reviews are concerned with evaluating test accuracy. A new test may benefit patients because it offers an improvement in accuracy compared to existing tests. Alternatively, a new test may have similar accuracy to existing tests but with the advantage of being quicker, cheaper or easier to perform so that tests are available to more patients and results are obtained more quickly.

Learn more:

• What are systematic reviews?
• What are diagnostic test accuracy reviews?

Cochrane is delighted to announce the signing of a new contract with John Wiley & Sons, Ltd. to publish the Cochrane Library for the next 10 years from January 2021. The agreement guarantees major investment into future development of the Library to sustain Cochrane as the world’s pre-eminent collection of high-quality evidence to inform global healthcare decision making. 

Cochrane’s Chief Executive Officer, Mark Wilson, warmly welcomed today’s announcement: “The Cochrane Library is central to Cochrane’s mission of producing and making available to the world high-quality, relevant, accessible systematic reviews and other evidence synthesis. Traffic to the Library has greatly increased over the past seven years as we have made  it accessible in 12 languages and we have built a publishing platform that will enable us to deliver new journals, new databases and new features that will help us meet that mission as never before.   We are confident we have a strong strategic partner with whom to work on the longer-term publishing challenges and opportunities.”

 Cochrane’s current publishing contract with Wiley ends on 31st December 2020. Following a competitive tender process beginning in May 2019 that attracted bids from numerous publishers, Wiley was selected due to its commitment to product development and innovation; a strategic vision meeting the needs of users of Cochrane’s evidence; and, support for the organization’s multi-lingual strategy, thus increasing the accessibility of its evidence globally.

The agreement also secures a strong financial framework to support Cochrane’s organizational ambitions in the next decade, including its Open Access aspirations. Currently, more than 3.6 billion people have free one-click access to the Cochrane Library, with nearly 70% of all 8,300 Cochrane Reviews and all 2,400 Review protocols available to everyone across the world. 

“Cochrane is the world-leading provider of medical evidence to support clinical effectiveness,” said Jay Flynn, Senior Vice President and Chief Product Officer, Research at Wiley. “We are confident this new agreement provides a strong framework within which to sustain Cochrane’s success and advance its future growth.”

Karla Soares-Weiser, Cochrane’s Editor in Chief, said: “The Cochrane Library is pivotal in delivering Cochrane’s mission of producing high-quality, relevant, up-to-date systematic reviews and other synthesized research evidence to inform health decision making. Future publication and dissemination of our content are key to meeting Cochrane’s strategic goals and the long-term financial health of our global organization.”

• Read more about Cochrane's future publishing agreement with Wiley. 
• To find out more about Cochrane and our health evidence visit: www.cochrane.org, the Cochrane Library or Cochrane Library in Spanish. 

In May 2020, Cochrane Sweden organised a one week, 40-hour online training course attracting 26 doctoral students and Cochraneities from all around the world. This training event was co-organised with the support of Cochrane Nordic, Cochrane Norway, Cochrane Sustainable Health Care and the Faculty of Medicine of Lund University.

Morning sessions organised via zoom videolink included lectures and hands-on training on all steps of the systematic review process, from registering the title, defining the research question, discussing on issues around structure and registration of the protocol, searching, assessing the risk of bias, with special emphasis given on the RoB tool 2, and by using platforms like COVIDENCE and RevMan Web along with sharing some useful tips and tricks on their use.

The values of Cochrane systematic reviews have been emphasised, and some common mistakes and good examples of how a well designed CSRs should look like were shared. In light of such good examples, Barbara Nussbaumer-Streit, the lead author of the recently published CSR on Quarantine shared the findings of the review and also presented interesting methodological aspects of her work. 

The cherry on top, as it is supposed to be, was saved for assessing the certainty of evidence, with Karsten Juhl Jørgensen from Cochrane Nordic sharing useful information about the great GRADE.

The whole course was organised in such a way to allow optimal time for short lecture-based education, small-group discussions, individual work with excercises on concrete methodological examples and mutual discussions, but also provided time for meeting people, chatting and getting to know each other. Afternoons were reserved for participants' individual work on Cochrane Interactive Learning (CIL) modules, which followed the topics covered during the morning sessions, so that by the end of the course, they all went through all the available CILs, and earned individual certificates.

The course was filled with lively, spontaneous discussions, allowed oportunities for exchange of experiences, building Cochrane networks and strengthening cooperations. To colleagues from Cochrane this was a nice chance to meet at least online, as besides Barbara and Karsten, the course brought together Liliya from Cochrane Russia, Tina from Cochrane Croatia, Rebecka from Cochrane IT Services and the hosts and organisors Matteo and Minna from Cochrane Sweden.

This course also pointed out that in challenging time like these are, when face-to-face contacts are made impossible, all opportunities and resources available should be used, both in technology, but people power as well, to give our best in sharing knowledge and Cochrane mission. 

As for Cochrane Sweden, it has been, as a very skilled three-year old, taking giant steps forward, and has, in these three years since it has been established, enriched the Cochrane community with ideas and enthusiasm, Mediterranean charm and  Scandinavian discipline.

Sincere congratulations to Matteo, Minna, Dina, Martin and all members of Cochrane Sweden and best wishes in their future work.

• Visit the Cochrane Sweden website
• Visit Cochrane Training to view future training events and resources

This month marks the 100th edition of Cochrane Journal Club.

Aimed at trainees, researchers, and practitioners, each Journal Club covers a single Cochrane Review of special interest, selected from the new and updated reviews published in the Cochrane Library. They highlight practice-changing findings, controversial conclusions, new methodology, evidence-based methods, and reviews from diverse health and social care topics

The Journal Club resources provide everything you need to present a relevant and interesting paper at your next journal club, or simply to explore a review in more depth on your own.

Journal Club is edited by Dr. Bill Cayley, he has overseen 100 editions of Journal Club. To mark the 100th edition we wanted to thank Bill and let new Cochrane Members know about Journal Club and remind existing members of this popular resource.

In this interview with Bill we find out more about Journal Club.

Bill, tell us about yourself and why you enjoy editing Journal Club?
I have been practicing rural family medicine and teaching at a community-based family medicine residency for 20 years. Incorporating evidence into clinical practice has been an important principle for me ever since I first heard of evidence-based medicine and the Cochrane collaboration in the early 1990s. I think it is important for both trainees and clinicians to understand how to work with primary evidence-based literature and editing the journal club gives me a chance to share practical examples of critical appraisal for clinical practice with others.

Tell us about Journal Club
The Journal Club is for anyone interested in staying up to date with current systematic reviews and staying fresh with critical appraisal of evidence for clinical practice. Each monthly journal club features a recent Cochrane review, as well as a clinical vignette and discussion questions to help readers explore real-life application of the evidence covered in the review.

What topics has it covered? Have any been very popular? Which reviews do you pick and why?
Each week the Cochrane Content Dissemination team assesses all new and updated Cochrane Reviews and creates a selects a review for Journal Club based on topicality, clinical relevance and ability to inform evidence-based practice. plan for communicating their results, making recommendations for Reviews to feature in Journal Club

The December 2019 issue on the Cochrane Review, “Clients’ perceptions and experiences of targeted digital communication accessible via mobile devices for reproductive, maternal, newborn, child, and adolescent health: a qualitative evidence synthesis” received the highest engagement in 2019 with 34.4% of people who received the email opening it.

How can someone sign up and what can they expect?
More details of how to sign up and access the most recent issue is here. Once signed up you will receive monthly Journal Club emails. Each focuses on a recently published Cochrane Review and comes with a Clinical Case to help you place the review in the context of a specific scenario and discussion questions to help you think about the review methods and findings in more detail; the monthly Cochrane Review featured is free to access for 30 days.

• More information about Journal Club

Cochrane systematic reviews can help us to make healthcare decisions based on up-to-date research evidence. They are systematic because they search for and analyse evidence in a systematic way, according to predetermined and published methods. Each systematic review answers a specific healthcare question by gathering all the relevant studies, assessing the reliability of these studies, then summarising their results to produce a summary of all of the available evidence.

One type of systematic review is a diagnostic test accuracy (DTA) review. In addition to investigating test accuracy, they ideally also investigate why the results may vary among studies, compare the performance of alternative tests, and help the reader to put the evidence in a clinical context. Watch the video below and read on to learn more about DTA reviews.

Cochrane DTA reviews are a type of systematic review that aim to evaluate the accuracy of diagnostic tests. They want to find out whether a new test is more accurate than an existing test, or whether it is quicker, cheaper or easier to perform. Answers to these questions help patients and healthcare workers make informed decisions about which test to use, based on up-to-date evidence. 

DTA reviews evaluate how well diagnostic tests (index tests) identify or exclude a particular disease or condition (the target condition). We know that diagnostic tests make errors, even when they are correctly performed. There are two types of test errors: false positive test errors (the index test suggests the target condition is present when it is not) and false negative test errors (the test suggests the target condition is absent when it is not). Cochrane DTA reviews can cover all types of diagnostic tests, from antibody tests to X-rays, for any disease or condition. It is really important that diagnostic tests provide accurate results so that people can receive prompt treatment or take preventive measures if necessary, and to avoid unnecessary testing, treatment and anxiety. 

DTA reviews search for all relevant test accuracy studies, appraise the studies for reliability, and combine their results. This gives the best possible estimate of the accuracy of an index test based on all the available evidence. DTA reviews are systematic because they search for and analyze evidence in a systematic way, according to predetermined and published methods.

Test accuracy studies most often report accuracy using sensitivity and specificity. 

• Sensitivity means the proportion of people with the target condition who are correctly detected by the index test. 
• Specificity means the proportion of people without the target condition who are correctly identified by the index test. 

Therefore, the nearer the sensitivity and specificity are to 100%, the better the test.

An alternative way to report test accuracy is using positive and negative predictive values, which tell us about the usefulness of a positive index test result and a negative index test respectively – this helps patients understand how reliable their test results are. Predictive values measure the number of positive index test results that will be true positives and the number of negative index test results that will be true negatives. The nearer the positive and negative predictive values are to 100%, the better the test. 

• View Cochrane DTA training for authors
• Visit the Cochrane Screening and Diagnostic Test Methods group website
• Learn more: What is the difference between a Cochrane systematic review of interventions and a Cochrane diagnostic test accuracy review?

In April 2020, Cochrane launched the COVID-19 consumer rapid response group. Currently, nearly 100 people with lived experience related to COVID-19 have joined the group, signing up to offer their time, skills, and experience to get involved with Cochrane’s work on COVID-19 rapid reviews and accommodate limited timelines. Thus far, 16 consumers have been connected with research teams for 13 COVID-19 rapid reviews, either as members of author teams or as peer reviewers. Interested consumers can still become involved in the COVID-19 consumer rapid response group; find out more and sign up.

As the full implications of the Coronavirus (COVID-19) pandemic became clear earlier in 2020, Cochrane made synthesizing relevant evidence for prevention and treatment its number one priority. Cochrane authors, editors, consumers, and other collaborators were motivated to do COVID-19 research, and Cochrane quickly mobilised its global community to undertake a series of rapid reviews, among other COVID-19 response work. The involvement of healthcare consumers (patients, carers, and the public) is a Cochrane policy and is part of guidance for the production of rapid reviews. With COVID-19, however, it quickly became clear that Cochrane needed to facilitate collaboration between review teams, editorial staff, and consumers in the short time available for completing a rapid review. 

Long-time Cochrane collaborator and patient and caregiver involvement researcher, Lyubov Lytvyn (@lyubovlytvyn), was interested in how Cochrane could use its platform. “I lead the patient and caregiver partnership initiative for the MAGIC/BMJ Rapid Recommendations (international clinical practice guidelines with linked systematic reviews, infographics, and decision aids), and am doing my PhD on this topic. When I saw Cochrane’s rapid reviews, I reached out to ask how they were involving consumers, to inform my own work. It turned out that, while it was part of their guidance, there wasn’t an easy process to help connect consumers and review teams in a short time frame.”

To address this, a task group was quickly formed, made up of consumers, researchers, and others who have led Cochrane’s consumer-involvement work. It swung into action, quickly identifying the ways in which tools and resources could be developed to help consumers and researchers partner together. Drawing on previous work - including Involving People (learning resource for systematic review authors), and Evidence Essentials (free online resource offering an introduction to health evidence and how to use it to make informed health choices) - the group put together a web page of resources, including:

• Learning for people who wanted to get involved;
• Support for volunteers, including a group of experienced consumers who could offer peer support;
• A series of “how to” one-page guidance for consumers and review teams; and
• Some short videos that explained how to get involved.

While putting together these resources, recruitment of volunteers from around the world with lived experience related to COVID-19 began, and the response was impressive. To date, 97 people have signed up to assist with the important task of providing consumer input into COVID-19 research. People can continue to get involved here.

 Ndi Euphrasia Ebai-atuh (@Euphras01426918) from Cameroon was the first consumer to be linked with a rapid review research team. The review looks at community-level interventions for improving access to food in low- and middle-income countries. Of the experience working with the team thus far, Euphrasia commented “I felt represented as a consumer even during ‘no time to waste’ research circumstances such as these, under the COVID-19 pandemic...It gave me a platform to amplify the voices of millions of consumers in LMICs with poor food access, despite numerous past and ongoing community-level interventions for improving access to food. I felt once more reassured of Cochrane’s commitment to consumer involvement and will call on the entire Cochrane community of researchers to take advantage of consumer involvement in research, for it can greatly improve evidence uptake!”

Jodie Doyle, Managing Editor of the Public Health Group overseeing the review added, “Not only did Euphrasia return her very useful comments to us within 7 days, upon follow-up she also provided advice on organisations and individuals to whom we should disseminate the published review.”

Vivek Podder was recruited for the protocol of the Cochrane rapid review, "Effectiveness of Contact Tracing Technologies in Epidemics", as a consumer referee for Cochrane Public Health. Jodie commented, “Vivek got his feedback to us quickly and provided really good insight from the perspective of a consumer in an LMIC. The editorial and authorship team are really grateful for his input.”

Over recent months, it has become clear that research on COVID-19 will be a priority for the foreseeable future. The voices of those with lived experience of this disease, whether as a patient, carer, or member of the public, will be important to producing relevant synthesized evidence going forward. Not all volunteers have been connected with research teams yet, and the task group is looking for new ways to involve consumers in Cochrane’s COVID-19 efforts. There are also plans to evaluate and present this innovative consumer involvement work for the wider research community.

Karla Soares-Weiser, Editor in Chief of the Cochrane Library, was enthusiastic about the process: “I’m delighted that we have been able to embed consumer involvement in our rapid review processes so efficiently. Involving stakeholders is critical to producing evidence that meets their needs, so it is fantastic to have this COVID consumer group available to provide high quality, rapid input that makes a difference to our reviews.”

Richard Morley, Consumer Engagement Officer for Cochrane, says “In these troubling times, it’s been so heartening to see people volunteering to help get the evidence that health professionals, patients, carers and policymakers need to respond to this public health crisis. Thank you to everyone.” 

• If you would like to learn more, please email consumers@cochrane.org. 
• Interested consumers can still become involved in the COVID-19 consumer rapid response group; find out more and sign up.

Find out more about Cochrane’s key achievements during 2018 and the strides being made on our major Strategy to 2020 initiatives.

"We exist so that people around the world can use Cochrane evidence to inform their health decision-making; and 2019 saw another substantial increase in the number of people who are doing that. In 2017, 22 million visits were made to Cochrane.org to access our evidence; in 2018 visits rose to 37 million; and in 2019 that figure more than doubled to over 77 million – that’s a 350% increase in only two years! Three-quarters of those users are accessing our evidence in non-English language browsers, so we are truly offering a service to healthcare practitioners, policymakers, researchers and patients and the general public around the world."

View or download the 2019 Annual Review. 

Cochrane Library Editor in Chief and Deputy Editor in Chief, Karla Soares-Weiser and Toby Lasserson, presented to a large group of international journalists as part of the Wiley Science Talks webinar. This webinar series, supported by the World Federation of Science Journalists and the Association of Health Care Journalists, provides educational webinars for journalists around the world.

Karla and Toby’s presentation, entitled “Understanding Health Evidence—A COVID-19 Case Study” introduced Cochrane, explained what systematic reviews are, and shared what makes Cochrane Systematic Reviews unique. They then presented an overview of Cochrane’s response to COVID-19 and shared a case study focusing on the quarantine rapid review. Using this review, they showed journalists what conclusions could be drawn from the study, how a well-written article about the review could be constructed, and the importance of keeping study results in context.

• Watch the full webinar  on Wiley YouTube
• Learn more about Cochrane’s response to COVID-19
  
  

The Cochrane Central Register of Controlled Trials (CENTRAL) is a highly concentrated source of reports of randomized and quasi-randomized controlled trials (RCTs) that publishes each month as part of Cochrane Library. CENTRAL assists Cochrane authors and other systematic reviewers around the world quickly find evidence to determine whether a treatment works.

We're pleased to announce that the May issue of CENTRAL on Cochrane Library includes approximately 14,000 references to RCTs identified from CINAHL (Cumulative Index of Nursing and Allied Health Literature) and published under license with EBSCO. CINAHL is an essential source of nursing research and publications on 17 allied health disciplines, including physical therapy, occupational therapy, nutrition and dietetics. Along with the RCTs in CENTRAL from PubMed, Embase, ClinicalTrials.gov, the World Health Organization’s International Clinical Trial Registry Platform (ICTRP), KoreaMed, and the individual registers of Cochrane Review Groups, CINAHL RCT records expand the subject area coverage of CENTRAL, making it an even more comprehensive source of RCTs.  

The project to include CINAHL RCTs in CENTRAL began in September 2018 with the help of our citizen scientist platform, Cochrane Crowd. Cochrane Crowd is a global community of volunteers who are helping to classify the research needed to support informed decision-making about health care.  The job of the Cochrane Crowd community is to review descriptions of research studies to identify and classify RCTs. Reports of RCTs are then fed into Cochrane’s Central Register of Controlled Trials.

Thanks to the efforts of the Cochrane Crowd community, Cochrane's Centralised Search Service Project Team and our colleagues at EBSCO, Metaxis, Wiley and HighWire, we are now adding CINAHL RCT records to CENTRAL. We will publish a “backlog” over the next three months that will contain older references as well as newer ones. New CINAHL records available from CENTRAL may increase results for saved searches. By August, we'll add new CINAHL RCTs to CENTRAL monthly just as we do for our other sources.

• Search CENTRAL
• Learn how CENTRAL is created
• Learn more about Cochrane Crowd

Telephone interventions for managing symptoms in adults with cancer. This is particularly important at the moment for people with cancer, who have been advised to stay at home due to COVID-19.

People with cancer experience a variety of symptoms such as depression, anxiety, fatigue and pain caused by their disease and its treatment. These are often managed, day-to-day, by patients or their family members. Poor management of symptoms may lead to other problems, such as difficulties in carrying out everyday tasks, poor sleep, and poor quality of life.

Cancer specialists have developed psychological and educational interventions to provide support for the management of a range of cancer symptoms. These interventions can often be delivered by telephone in the patients’ homes instead of face-to-face in hospital. This is beneficial for patients and their families, who would normally have to travel to hospital for outpatient appointments. This is particularly important at the moment for people with cancer, who have been advised to stay at home due to COVID-19.

Cochrane Review authors aimed to answer the following questions.

1. Are telephone interventions for adults with cancer effective in relieving symptoms of cancer and cancer treatment?
2. Which symptoms are most reduced when telephone interventions are used?
3. What aspects of telephone interventions have the most impact in reducing cancer symptoms?

In this systematic review, telephone interventions were interventions given only, or mainly, by telephone. They were given by health professionals.  As well as telephone contact, they could include face-to-face contact, or printed, digital or online information.

The review included 32 studies with a total of 6250 participants. Studies could compare telephone interventions with another telephone intervention, with another type of intervention (e.g. face-to-face), or with usual care. Participants in these studies were adults with any kind of cancer at any stage. Most studies (21) were from the USA. Nine studies recruited women with breast cancer, 11 included people with breast, colorectal, lung, or prostate cancer. Fourteen studies included people with early-stage cancer. Nurses provided interventions in 24 studies. Only 10 studies delivered interventions solely by telephone, and 16 studies combined telephone calls with other materials (printed or digital). Studies measured symptoms of depression, anxiety, emotional distress, uncertainty, fatigue, pain, sexual symptoms, and breathlessness. They also measured the effect of all the symptoms together (the general symptom experience).

Most studies compared a telephone intervention with usual care alone or usual care with additional support. Eight studies compared two telephone interventions against each other; some also compared these with usual care.

The review authors analysed the results from studies that recorded change scores, or for which they were able to calculate change scores.

Twenty-one studies provided evidence on symptoms of depression compared to usual care or other interventions, but only nine provided data that could give change scores. These found that telephone interventions appeared to reduce symptoms of depression. Likewise, telephone interventions appeared effective compared to usual care or other interventions in reducing anxiety (16 studies; 5 contributed change scores); fatigue (9 studies; 6 contributed change scores); and emotional distress (7 studies; 5 contributed change scores).

Telephone interventions are convenient for patients, their families and healthcare workers and they appear to relieve some symptoms of cancer and cancer treatment. However, the studies were small, very different from each other, and  some evidence was conflicting. It is unclear whether telephone interventions alone, or combined with face-to-face meetings, or printed or audio materials, are most effective in reducing the many symptoms that people with cancer experience. The authors rated the certainty of the evidence as very low.

This review includes evidence published up to January 2019.

• Read the systematic review
• Read the special collection on Coronavirus (COVID-19): Remote care through telehealth
• Read all the Cochrane resources and news on COVID-19