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Are laboratory-made, COVID-19-specific monoclonal antibodies an effective treatment for COVID-19?

Wed, 08/25/2021 - 12:00

'SARS‐CoV‐2‐neutralising monoclonal antibodies for treatment of COVID‐19' from Cochrane Haematology  published today in the Cochrane Library. 

Key messages

  • We do not know whether antibodies (the body’s natural defence against disease) made in a laboratory and all the same as one another (monoclonal) and designed to target COVID-19, are an effective treatment for COVID-19 because we assessed only six studies exploring different treatments in different types of patients.
  • We identified 36 ongoing studies that will provide more evidence when completed.
  • We will update this review regularly as more evidence becomes available.

We spoke to Nina Kreuzberger, Research Associate, who explained this review to us:

“In the rush to treat COVID patients, treatments have been used that are not yet supported by mature data. SARS-CoV-2 neutralising monoclonal antibodies (mAbs) are being used and bought widely, although their value is still under question. Multiple monoclonal antibodies or antibody cocktails, such as bamlanivimab, bamlanivimab with etesevimab, casirivimab with imdevimab, sotrovimab, and regdanvimab, have been investigated in one study each.

In non-hospitalised patients, mAbs may reduce the rate of hospitalisation or death, but effects on mortality alone, adverse events, serious adverse events and quality of life are uncertain or vary per substance due to small sample sizes, or are completely lacking. Data on bamlanivimab in hospitalised patients show little to no effect on mortality and hospital discharge, but may increase the occurrence of adverse events. Similarly, casirivimab with imdevimab has probably no effect on mortality and hospital discharge, data on adverse effects are lacking. These studies suggest that it would be valuable to take a look at subgroups of patients based on serostatus. 

We know there are 36 ongoing studies and look forward to updating this review to get a clearer picture on the benefits of this treatment soon.”

What are ‘monoclonal’ antibodies?
Antibodies are made by the body as a defence against disease. However, they can also be produced in a laboratory from cells taken from people who have recovered from a disease.

Antibodies that are designed to target only one specific protein – in this case, a protein on the virus that causes COVID-19 – are ‘monoclonal’. They attach to the COVID-19 virus and stop it from entering and replicating in human cells, which helps to fight the infection. Monoclonal antibodies have been used successfully to treat other viruses. They are thought to cause fewer unwanted effects than convalescent plasma, which contains a variety of different antibodies.

What did we want to find out?
We wanted to know if COVID-19 specific monoclonal antibodies are an effective treatment for COVID-19. We looked at whether they:

  • reduced the number of deaths from any cause;
  • improved symptoms or made them worse;
  • increased admissions to hospital; and
  • caused any serious or other unwanted effects.

What did we do?
We searched for studies that investigated one or more monoclonal antibodies to treat people with confirmed COVID-19 compared with placebo (sham treatment), another treatment or no treatment. Studies could take place anywhere globally and include participants of any age, gender or ethnicity, with mild, moderate or severe COVID-19.

We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and size.

What did we find?
We found six active studies including a total of 17,495 people. Four studies investigated non-hospitalised people with no symptoms or mild COVID-19. Two studies investigated hospitalised people with moderate to severe COVID-19. Studies took place across the world. Three studies were funded by pharmaceutical companies. The monoclonal antibodies they studied were bamlanivimab, etesevimab, casirivimab and imdevimab, sotrovimab, regdanvimab. We did not identify data for mortality at 60 days and quality of life.

Non-hospitalised people, with no symptoms or mild COVID-19 (four studies)
One study investigated different doses of bamlanivimab (465 people), compared to placebo.

We don’t know whether bamlanivimab:

  • increases or reduces the number of deaths because no participants died within 30 days of treatment;
  • causes more or fewer serious unwanted effects because there were few events.

Bamlanivimab may reduce the number of admissions to hospital within 30 days of treatment compared to placebo.

  • May cause slightly fewer unwanted effects than placebo.
  • We did not find data for improved symptoms or worsened symptoms.

One study investigated a combination of bamlanivimab and etesevimab (1035 people), compared to placebo.

  • Bamlanivimab and etesevimab may reduce the number of deaths and admissions to hospital.
  • May cause slightly more unwanted effects.
  • May cause more serious unwanted effects.

For treatment with bamlanivimab alone or in combination with etesevimab we did not find data for improved symptoms or worsened symptoms.

One study (phase 1/2 with 799 people) investigated different doses of casirivimab combined with imdevimab, compared to placebo.

  • Casirivimab combined with imdevimab may reduce the number of hospital admissions or death.
  • We don't know whether casirivimab and imdevimab causes more unwanted (grades 3 and 4) and serious unwanted effects than placebo because there were too few deaths to allow us to make a judgment.
  • We did not find data for the number of people who died at day 30 and development of severe symptoms.
  • We did not include results from phase 3 (5607 people) of this study, because of high risk of bias, as it was not clear which participants were included in the analysis.

One study (583 people) investigated sotrovimab, compared to placebo.
We don't know whether sotrovimab:

  • increases or reduces the number of deaths and people requiring invasive mechanical ventilation or dying, because there were too few deaths to allow us to make a judgment.
  • Sotrovimab may reduce the number of people requiring oxygen, unwanted (grades 3 to 4) and serious unwanted effects;
  • may have little or no effect on unwanted effects (all grades).

Another study (327 people) investigated different doses of regdanvimab (40 mg/kg and 80 mg/kg), compared to placebo.

  • Regdanvimab at either dose may reduce the number of admissions to hospital or death.
  • May increase unwanted events (grades 3 to 4).
  • Regdanvimab at a dose of 80 mg/kg may reduce unwanted effects (all grades) and 40 mg/kg may have little to no effect.
  • We don't know whether regdanvimab increases or decreases the number of deaths, requirement for invasive mechanical ventilation, and serious unwanted effects,  because there were too few events to allow us to make a judgment.

Hospitalised people with moderate to severe COVID-19 (2 studies)
One study (314 people) investigated bamlanivimab compared to placebo.

  • We don’t know whether bamlanivimab increases or decreases the number of deaths due to any cause up to 30 or 90 days after treatment because there were too few deaths to allow us to make a judgment (6 deaths with bamlanivimab and 4 deaths with placebo in 314 people).
  • Bamlanivimab may slightly increase the development of severe COVID-19 symptoms five days after treatment and the number of people with unwanted effects.
  • Bamlanivimab may have little to no effect on time until discharge from hospital.
  • We don’t know whether bamlanivimab causes serious unwanted effects by day 30 because the study was small and reported few serious unwanted effects.

Another study (9785 people) investigated casirivimab combined with imdevimab, compared to standard of care.

  • Casirivimab combined with imdevimab has probably little to no effect on the number of deaths, requirement for invasive mechanical ventilation or death, and hospital discharge alive.
  • We did not find data for unwanted and serious unwanted effects.

What are the limitations of the evidence?
Our confidence in the evidence is low because we found only six studies, and they did not report everything we were interested in, such as the number of deaths within 60 days and quality of life. We found 36 ongoing studies. When they are published, we will add their results to our review. These results are likely to change our conclusions and will also help us understand how new variants affect how well monoclonal antibodies work.

How up to date is this evidence?
The evidence is up to date to 17 June 2021.

Thursday, September 2, 2021

Catherine Marshall re-appointed Co-Chair of the Governing Board

Tue, 08/24/2021 - 15:16

The Governing Board voted unanimously to re-appoint Catherine Marshall for a second term as Co-Chair from September  2021 until September 2023. Catherine will continue to work alongside fellow Co-Chair, Tracey Howe.
The Governing Board is responsible for setting Cochrane's strategic direction and overseeing the work of the Chief Executive Officer, Editor in Chief, and Central Executive Team, which leads, coordinates and supports all the operational work across Cochrane Groups to deliver the organization's strategic goals.

Outside Cochrane, Catherine is a Health Sector consultant based in New Zealand specialising in policy, evidence-based healthcare, consumer engagement guideline development and implementation. She is currently Co-Chair of the Partnership Advisory Group with the Guidelines International Network (G-I-N) and is an Honorary Patron of G-IN  and previously Vice Chair of G-I-N's board of trustees for 9 years.

Catherine has a long history in guideline development and was  the inaugural Chief Executive of the New Zealand Guidelines Group, which often relied on evidence from the Cochrane Library. Catherine is also a prominent health consumer advocate, working on the development of health consumer legislation in New Zealand and as a former member of the NZ Stronger Consumer Voices Alliance and the NZ Health and Disability Non-Government Organisation Council. In 2018, she helped organize and participate in the consumer programs for the Cochrane Colloquium in Edinburgh. She is currently Co-Chair of the wellington Free Ambulance Consumer Council.
Of her appointment, Catherine says, “I continue to be been deeply impressed by the strength of Cochrane and the talent of the people who contribute to the collaboration. The work of the Collaboration during the pandemic has been phenomenal - and it has been wonderful to see our work applied and valued during a time of global emergency. I am strongly committed to continuing to building a vibrant and trusted organisation that will have a strong future, expanding our reach around the globe and finding new ways Cochrane advice can inform health decisions.”

Tuesday, August 24, 2021

Special Collection: Stillbirth prevention and respectful bereavement care

Thu, 08/19/2021 - 19:34

Cochrane Library Special Collections provide a round-up of up-to-date Cochrane evidence on a specific topic. This Special Collection has been created to highlight evidence-based interventions to reduce stillbirth and improve care for families after stillbirth and in a subsequent pregnancy, identify women at increased risk of stillbirth, and improve knowledge of causes of and contributors to stillbirth. 

Stillbirth is a major public health problem with an enormous global mortality burden and psychosocial impact on women, families, communities, and health systems. Despite the scale of the problem and potential for prevention, stillbirth has been largely neglected in global public health. While there has been some improvement in the global stillbirth rate over the past 20 years, much more needs to be done.  Efforts to ensure optimal care throughout the COVID-19 pandemic are critical, particularly for disadvantaged populations. 

This Special Collection was a collaborative effort with members of the Stillbirth Centre of Research Excellence, the International Stillbirth Alliance, and others.

Topics  of the Special collection include: 

A special Evidently Cochrane blog post for maternity care providers and families has also been published. Dr Aleena Wojcieszek, clinical epidemiologist, science communicator, and honorary research fellow at the Australian Centre of Research Excellence in Stillbirth (Stillbirth CRE), and Ms Susannah Hopkins Leisher, mom to stillborn son Wilder Daniel (13 July 1999), PhD student in epidemiology at Columbia University, and chair of the International Stillbirth Alliance, look at an overview of Cochrane evidence on antenatal interventions to prevent stillbirth and perinatal death. This review is included in the Special Collection. 


Tuesday, August 24, 2021

Launching Cochrane methods guidance in Russian

Wed, 08/18/2021 - 19:14

Cochrane is delighted to launch a Russian translation of MECIR (Methodological Expectations for Cochrane Intervention Reviews) from Cochrane Russia.

This is the third translation of Cochrane’s methods guidance since the launch of version 6 of the Cochrane Handbook for Systematic Reviews of Interventions (see this Cochrane Editorial for more details about the Handbook’s launch). It is another important milestone in supporting the engagement of people with different native languages in Cochrane Reviews.

Access the Russian translation of MECIR.

You can also access the translated versions of MECIR in Spanish and in Japanese.

Ensuring that Cochrane Reviews represent the highest possible quality is critical if they are to inform decision making in clinical practice and health policy. MECIR are Standards that guide the conduct and reporting of Cochrane Intervention Reviews; they are essentially the ‘how-to’ guide for Cochrane Reviews and are drawn from the Cochrane Handbook for Systematic Reviews of Interventions. All Standards are tagged as ‘mandatory’ or ‘highly desirable’. Mandatory Standards should always be met unless an appropriate justification for not doing so can be provided. Highly desirable Standards should generally be implemented but justification for not implementing them is unnecessary. 

The development of MECIR has been a collaborative effort over the years, involving review authors, editors and methodologists from all corners of our community. We are thrilled that this collaboration now includes Cochrane Translation Teams.

Professor Liliya Eugenevna Ziganshina, Director of Cochrane Russia, said “At Cochrane Russia we are happy and privileged to contribute to the translation of Cochrane MECIR Standards. This has been a fascinating experience, a learning opportunity and empowering exercise for all involved! The uptake of Cochrane review Plain Language Summaries in Russia has been growing recently, especially in the new pandemic reality. Appreciation and respect of Cochrane as the global research community and its work in multilingual changing world is high in Russia. We hope that the Russian version of MECIR will contribute to higher quality of research output, to review and methods training in Russia, and to overall better understanding and use of Cochrane reviews in Russia and beyond."

Post written by Judith Deppe (Multi-language Programme Manager, Cochrane) and Ella Flemyng (Methods Implementation Manager, Cochrane)

Additional resources:

Monday, August 23, 2021

Job vacancy: Research Assistant in E-Cigarettes Evidence Synthesis - Oxford, UK

Mon, 08/16/2021 - 18:09

Location: Radcliffe Primary Care Building, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG
Pay grade: £29,176 - £32,817 p.a.
Start date: Jan 2022
Length: Funded for 18 months in the first instance
Closing date:  12.00 midday on 7 Sept 2021
Interviews: week commencing 13 Sept 2021

Applications are invited for a research assistant to work as part of a team with  Dr. Jamie Hartmann-Boyce and Dr Nicola Lindson from Cochrane Tobacco Addiction group  on an evidence synthesis project on the impact of e-cigarette use and availability on smoking in young people.

They wish to appoint an enthusiastic candidate with knowledge of systematic reviewing and/or addiction research. You will conduct screening, data extraction, and quality assessment for the review. The ideal candidate will have experience of conducting a systematic review, will hold an MSc or above in a health-related discipline (or be close to completing an MSc), and have a working knowledge of epidemiological statistics and a high level of attention to detail.

Monday, August 16, 2021 Category: Jobs

Are corticosteroids given orally or by injection an effective treatment for people with COVID-19?

Tue, 08/10/2021 - 10:22

 Are corticosteroids (anti-inflammatory medicines) given orally or by injection an effective treatment for people with COVID-19?

Key messages

  • Corticosteroids (anti-inflammatory medicines) given orally or by injection (systemic) are probably effective treatments for people hospitalised with COVID-19.  The authors don’t know whether they cause unwanted effects. 
  • The authors don’t know which systemic corticosteroid is the most effective. They found no evidence about people without symptoms or with mild COVID-19 who were not hospitalised. 
  • They found 42 ongoing studies and 16 completed studies that have not published their results. The authors will update this review when we find new evidence.    

What are corticosteroids?

Corticosteroids are anti-inflammatory medicines that reduce redness and swelling. They also reduce the activity of the immune system, which defends the body against disease and infection. Corticosteroids are used to treat a variety of conditions, such as asthma, eczema, joint strains and rheumatoid arthritis. 

 Systemic corticosteroids can be swallowed or given by injection to treat the whole body. High doses of corticosteroids taken over a long time may cause unwanted effects, such as increased appetite, difficulty sleeping and mood changes. 

 Why are corticosteroids possible treatments for COVID-19? 

COVID-19 affects the lungs and airways. As the immune system fights the virus, the lungs and airways become inflamed, causing breathing difficulties. Corticosteroids reduce inflammation, so may reduce the need for breathing support with a ventilator (a machine that breathes for a patient). Some patients’ immune systems overreact to the virus causing further inflammation and tissue damage; corticosteroids may help to control this response.

What did we want to find out?

The authors wanted to know whether systemic corticosteroids are an effective treatment for people with COVID-19 and whether they cause unwanted effects.

They were interested in:

  • deaths from any cause up to 14 days after treatment, or longer if reported;
  • whether people got better or worse after treatment, based on their need for breathing support;
  • quality of life;
  • unwanted effects and infections caught in hospital.

What did the authors do? 
 They searched for studies that investigated systemic corticosteroids for people with mild, moderate or severe COVID-19. People could be any age, sex or ethnicity.

Studies could compare:

  • corticosteroids plus usual care versus usual care with or without placebo (sham medicine);
  • one corticosteroid versus another;
  • corticosteroids versus a different medicine;
  • different doses of a corticosteroid; or
  • early versus late treatment.

They compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.

What did they find? 

The team found 11 studies with 8075 people. About 3000 people received corticosteroids, mostly dexamethasone (2322 people). Most studies took place in high-income countries. 

They also found 42 ongoing studies, and 16 completed studies that have not yet published their results. 

Main results

Ten studies compared corticosteroids plus usual care versus usual care with or without placebo. Only one study compared two corticosteroids. The studies included only hospitalised people with confirmed or suspected COVID-19. No studies looked at non-hospitalised people, different doses or timing, or provided information about quality of life.

Corticosteroids plus usual care compared to usual care with or without placebo (10 studies)

  • Corticosteroids probably reduce the number of deaths from any cause slightly, up to 60 days after treatment (9 studies, 7930 people).
  • One study (299 people) reported that people on a ventilator at the start of the study were ventilation-free for more days with corticosteroids than with usual care, so corticosteroids may improve people’s symptoms.
  • Four studies (427 people) reported whether people not on a ventilator at the start of treatment later needed to be put on a ventilator, but we could not pool the studies’ results, so we are unsure if people’s symptoms get worse with corticosteroids or usual care.
  • The authors don’t know if corticosteroids increase or reduce serious unwanted effects (2 studies, 678 people), any unwanted effects (5 studies, 660 people), or infections caught in hospital (5 studies, 660 people).

Methylprednisolone versus dexamethasone (1 study, 86 people)

  • The authors don’t know whether the corticosteroid methylprednisolone reduces the number of deaths from any cause compared to dexamethasone in the 28 days after treatment.
  •  The authors don’t know if methylprednisolone worsens people’s symptoms compared to dexamethasone, based on whether they needed ventilation in the 28 days after treatment.
  • The study did not provide information about anything else we were interested in.

What are the limitations of the evidence?

The authors are moderately confident in the evidence about corticosteroids’ effect on deaths from any cause. However, their confidence in the other evidence is low to very low, because studies did not use the most robust methods, and the way results were recorded and reported differed across studies. The author team did not find any evidence on quality of life and there was no evidence from low-income countries or on people with mild COVID-19 or no symptoms, who were not hospitalised. 

This evidence is up to date to 16 April 2021.


Lead authors explain the evidence

Lead Cochrane Haematology authors Carina Wagner from University of Cologne and Mirko Griesel from University of Leipzig Medical Centre said,

 “Corticosteroids given orally or by injection probably have a small benefit in the treatment of people hospitalised with COVID-19, however we don’t know whether they also cause unwanted effects.

At this stage we don’t know which systemic corticosteroid is the most effective and we found no evidence about people without symptoms or with mild COVID-19 who were not hospitalised. We found 42 ongoing studies and 16 completed studies that have not yet published their results. We will update this review when we find new evidence about this treatment which is relatively low cost and available in large parts of the world.”


Tuesday, August 17, 2021

What can individuals do to avoid the effects of air pollution?

Tue, 08/03/2021 - 19:45

 What can individuals do, especially those with long-term breathing problems, to avoid the effects of air pollution?

This recently published Cochrane review explores this question, and we sat down with the lead author of the review to discuss the review findings. 

Tell us about this Cochrane review…What did you find out?

The main thing that we found out from this review is that we are really lacking evidence on the importance of different interventions to reduce the impact of air pollution on the health of individuals with lung conditions. As well as finding very few studies covering the topic to include in the review, the ones that were found all used different methods, which meant that it was difficult to combine them and derive conclusions from them. This was disappointing, but certainly not unexpected. 

 Can individuals looking to protect themselves from air pollution take anything from this review?

People living with chronic conditions (such as asthma and COPD) have real concerns about being exposed to air pollution and often ask what they can do to ensure that they protect themselves most effectively. Common questions we receive at the European Lung Foundation are about how to commute to work while avoiding exposure and the best time to exercise or go out walking. There are lots of common-sense suggestions and advice that we can provide them with, but it would be much more beneficial to have evidence-based recommendations. These evidence-based recommendations are also needed for healthcare professionals to ensure that they can best advise their patients when they see them regularly in their clinics. 

There is little from this review that can really add to what we would already advise, but some studies did reinforce the tips we would currently give: for example using a mask or a lower pollution cycle route may reduce some of the physiological impacts from air pollution. 

Given the studies you found and the challenge this presented in drawing any conclusions, what could helpfully happen next?

This review should be a call to action to individuals working in the field to carry out more studies looking at the health outcomes of people living with chronic conditions when using specific interventions to reduce exposure to air pollution – such as changing routes, using air quality indexes, masks etc. Larger and longer studies that recruit participants with pre-existing chronic conditions and that include patient-important outcomes (such as exacerbations, hospital admissions, quality of life and adverse events) are urgently needed.

Monday, August 9, 2021

Remdesivir for the treatment of COVID-19

Tue, 08/03/2021 - 18:30

In this recently published Cochrane review, authors explored the effects of treating COVID-19 with remdesivir, an antiviral medication.

First author Kelly Ansems said "Based on the currently available evidence remdesivir probably has little or no effect on all-cause mortality at up to 28 days in hospitalised adults with SARS-CoV-2 infection. We are uncertain about the effects of remdesivir on clinical improvement and worsening."

Key messages

  • For adults hospitalised with COVID-19, remdesivir probably has little or no effect on deaths from any cause up to 28 days after treatment compared with placebo (sham treatment) or usual care. 
  • The review authors are uncertain whether remdesivir improves or worsens patients’ condition, based on whether they needed more or less help with breathing.
  • Researchers should agree on key outcomes to be used in COVID-19 research, and future studies should investigate these areas. This would allow future updates of this review to draw more certain conclusions about the use of remdesivir to treat COVID-19.

What is remdesivir?

Remdesivir is a medicine that fights viruses. It has been shown to prevent the virus that causes COVID-19 (SARS-CoV-2) from reproducing. Medical regulators have approved remdesivir for emergency use to treat people with COVID-19. 

What did authors want to find out?

The authors of this review wanted to know if remdesivir is an effective treatment for people in hospital with COVID-19 and if it causes unwanted effects compared to placebo or usual care.

People with COVID-19 are given different kinds of breathing support, depending on how severe their breathing difficulties are. The authors used the types of breathing support people received as a measure of the success of remdesivir in treating COVID-19. Types of breathing support included:

  • for severe breathing difficulties: invasive mechanical ventilation, when a breathing tube is put into patients’ lungs, and a machine (ventilator) breathes for them. Patients are given medicine to make them sedated whilst they are on a ventilator.
  • for moderate to severe breathing difficulties: non-invasive mechanical ventilation through a mask over the nose and/or mouth, or a helmet. Air or oxygen is pushed through the mask. Patients are generally awake for this treatment.
  • for moderate breathing difficulties: oxygen via a mask or prongs that sit in the nostrils. Patients can still breathe room air.

The authors were interested in the following outcomes:

  • deaths from any cause in the 28 days after treatment;
  • whether patients got better after treatment, measured by how long they spent on mechanical ventilation or oxygen;
  • whether patients’ condition worsened so that they needed oxygen or mechanical ventilation;
  • quality of life;
  • any unwanted effects; and 
  • serious unwanted effects.

What did the authors do? 

They searched for studies that investigated remdesivir to treat adults with COVID-19 compared to placebo or standard care. Patients were hospitalised with COVID-19 and could be of any gender or ethnicity.  

They compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes.

What did they find? 

They found 5 studies with 7452 people hospitalised with COVID-19. Of these, 3886 people were given remdesivir. The average age of patients was 59 years. Studies took place around the world, mainly in high- and upper-middle-income countries. 

Main results 

The included studies compared remdesivir to placebo or usual care in people hospitalised with COVID-19 for up to 28 days.

Deaths from any cause

Remdesivir probably makes little or no difference to deaths from any cause (4 studies, 7142 people). In 1000 people, 8 fewer die with remdesivir compared to placebo or standard care.

Did patients get better with remdesivir?

  • Remdesivir may have little or no effect on the length of time patients spent on invasive mechanical ventilation (2 studies, 1298 people). 
  • The authors do not know whether remdesivir increases or decreases time on supplemental oxygen (3 studies, 1691 people).

Did patients get worse with remdesivir?

  • Authors do not know whether patients are more or less likely to need any mechanical ventilation (invasive or non-invasive) with remdesivir (3 studies, 6696 people).
  • Patients may be less likely to need invasive mechanical ventilation (2 studies, 1159 people).
  • Authors do not know whether patients are more or less likely to need non-invasive mechanical ventilation (1 study, 573 people). 
  • Authors do not know whether patients are more or less likely to need oxygen by mask or nasal prongs (1 study, 138 people).

Quality of life

None of the included studies reported quality of life.

Unwanted effects

  • Authors do not know whether remdesivir leads to more or fewer unwanted effects of any level (3 studies, 1674 people). 
  • Patients are probably less likely to experience serious unwanted effects with remdesivir than with placebo or standard care (3 studies, 1674 people). In 1000 people, 63 fewer would experience a serious unwanted effect compared to placebo or standard care.

What are the limitations of the evidence?

The authors of this review are moderately confident in the evidence for deaths from any cause and serious unwanted effects; however, their confidence in the other evidence is limited because studies used different methods to measure and record their results, and the review authors did not find many studies for some of the outcomes of interest. 

How up-to-date is this evidence?

The evidence is current to 16 April 2021.

Thursday, August 5, 2021

Apply now: the 2021 Cochrane-REWARD prize for reducing waste in research

Fri, 07/30/2021 - 17:09

 Deadline for submissions: 24 September

Nominations are open for the 2021 Cochrane-REWARD prize, which recognizes initiatives that have potential to reduce research waste. 

An estimated $170 billion of research funding is wasted each year because its outcomes cannot be used [1]. The waste occurs during 5 stages of research production: question selection, study design, research conduct, publication, and reporting [2,3]. Much of this waste appears to be avoidable or remediable, but there are few proposed solutions. 

The Cochrane-REWARD prize was established in 2017 to stimulate and promote research in this area.  

Cochrane is now calling for nominations for the 2021 prize.

This year, the prize committee especially encourages submissions related to tackling COVID-19 research waste. 

The COVID-19 pandemic has seen research published at an unprecedented scale, and it is likely that many of the existing research waste issues have been amplified [5]. However, there are also notable examples of efforts to reduce waste and we are keen to highlight some of these. 

All nominations will be assessed using the following criteria:

  1. The nominee has addressed at least one of the 5 stages of waste (questions, design, conduct, publication, reporting) in health research;
  2. The nominee has pilot or more definitive data showing the initiative can lower waste;
  3. The initiative can be scaled up;
  4. The estimated potential reduction in research waste that the initiative might achieve.

Nominations for the 2021 prize should be submitted by 24 September 2021. Two prizes will be awarded (a 1st prize of £1500 and a 2nd prize of £1000), but other shortlisted candidates will also be highlighted to help disseminate good ideas.

The winners of the 2021 prize will be announced in a virtual ceremony later in the year, where they will also be given the opportunity to present about their work.


  1. Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet. 2009 Jul 4;374(9683):86-9.
  2. Macleod MR, Michie S, Roberts I, et al. Biomedical research: increasing value, reducing waste. Lancet. 2014 Jan 11;383(9912):101-4.
  3. Glasziou P, Altman DG, Bossuyt P, et al. Reducing waste from incomplete or unusable reports of biomedical research. Lancet. 2014 Jan 18;383(9913):267-76.
  4. Glasziou, P and Chalmers, I. Research waste is still a scandal—an essay by Paul Glasziou and Iain Chalmers. BMJ. 2018 Nov 12;363:k4645
  5. Glasziou P, Sanders S and Hoffmann T. Waste in covid-19 research BMJ. 2020 May 12;369:m1847.
Monday, August 2, 2021

Tackling methodological challenges in public health reviews

Tue, 07/27/2021 - 11:49

The Cochrane Methods team has defined a programme of work to improve the quality and impact of Cochrane reviews in public health with the support of the Methods Executive, Methods Groups and Public Health and Health Systems Network. The programme has been designed to foster collaboration between Methods Groups and Cochrane Review Group (CRG) Networks and to support the ongoing response to COVID-19. It focuses on producing high-priority public health reviews and delivering user-friendly resources to improve the planning, conduct and reporting of methods within them.

Why focus on public health?
Public health reviews, especially those relating to COVID-19, are often highly scrutinised and have wide-ranging impacts on policy and global health outcomes. However, public health reviews typically address complex questions and use a range of complex methods that are considered non-standard in Cochrane, and existing guidance is not always being applied accurately or consistently. In the Cochrane context, public health reviews are defined as those that include diverse sources of evidence (e.g., not solely RCTs), complex interventions that are delivered at the population level (e.g., policies rather than drugs or treatments), exposures that cannot be delivered in randomized controlled trials (e.g. studying the effects of a chemical or viral exposure), and outcomes that measure something other than efficacy (e.g., harms, process outcomes, implementation or costs).

How will the programme support review production?
The programme of work is based on the premise that high-quality, timely review production requires expert methodological support and pragmatic resources that help authors and editors translate Handbook guidance into practice. The topics and approach have been designed to bring CRGs and Methods Groups together to ensure the projects and their outputs are designed with the needs of Cochrane editors and authors in mind.

Though the focus is on public health reviews, the challenges faced within them are often encountered in other topic areas, such as choosing when and how to include non-randomised studies of interventions, assessing bias in non-randomized studies of interventions, planning a useful synthesis in light of complexity and heterogeneity, incorporating qualitative evidence, and reporting results when a meta-analysis has not been possible. By tackling the challenges in a COVID-priority area, the aim will be to develop, adapt and apply the tools more widely across Cochrane. The Methods Support Unit plays an important role in bridging the gap between CRGs and Methods Groups and will be embedded in the projects to support capacity-building.

What has happened so far?
The Cochrane Methods team mapped the most frequently cited challenges from two recent methods surveys of CRGs by methodological area and listed possible projects to address them. The projects were then shortlisted considering extent of author and CRG need, potential for impact, and the anticipated time and resources required to deliver a useful output. The projects have been refined with Cochrane’s Methods Executive and project teams are now being brought together. Each has been designed to deliver a practical tool or decision aid for editors or authors by the end of 2021 that harnesses existing theory so that it can be more easily applied.

  • Project 1: Preferred and accepted risk of bias tools for assessing bias in non-randomised studies of interventions
  • Project 2: Practical guidance to frame public health intervention review questions, define outcomes and choose appropriate study designs
  • Project 3: Standard terminology to help authors describe different study designs appropriately and consistently
  • Project 4: Practical conduct and reporting guidance for assessing risk of bias in non-randomised studies of interventions and/or ROBINS-I
  • Project 5: Practical tools to implement SWiM reporting guidance to improve pre-specification and presentation of findings

In addition to the projects, plans are underway to deliver a suite of learning resources around qualitative evidence synthesis, and to house a bank of exemplar reviews showcasing best practice. A Methods Symposium will also take place in October 2021 covering a range of methodological challenges relating to public health reviews and complex interventions. The symposium will be followed by a methods implementation surgery led by the Methods Support Unit and aimed at CRGs in November 2021 to discuss the outputs that were developed and how they can support editors and authors.

How can I get involved?
Each project will be encouraged to use Task Exchange to call for volunteers across the community to provide feedback on the first draft of the tools and resources being developed. Those interested in getting involved are encouraged to create a profile or contact the Methods Team directly to enquire about other ways to contribute.

Additional resources:

Tuesday, July 27, 2021

Launch of World Evidence-Based Healthcare Day 2021: the role of evidence in an infodemic

Mon, 07/26/2021 - 19:24

World Evidence-Based Healthcare Day will take place again this year on 20 October – learn more on the website

On World Evidence-Based Healthcare (EBHC) Day, seven leaders in evidence-based healthcare spotlight the global impact of evidence on healthcare research, policy, practice and health outcomes.

Today JBI, Cochrane, Campbell Collaboration, GIN, the Institute for Evidence-Based Healthcare, the Centre for Evidence-based Health Care and NICE launch the World EBHC Day 2021 campaign, ‘the role of evidence in an infodemic’. 

The 2021 campaign supports the infodemic management efforts of the World Health Organization (WHO) by exploring the role of evidence in an infodemic, in particular promoting access to trustworthy, evidence-informed health information.

“The COVID-19 pandemic has highlighted the importance of developing rapid evidence-informed responses and ensuring the best available evidence is accessible, transparent and understood. The rapid response of the global evidence community has been important and necessary. However, it has been accompanied by the exponential production of misinformation which has contributed to the creation of a global infodemic,” explains Bianca Pilla, World EBHC Day Committee Chair.

The overabundance of information and the distribution of misinformation is amplified through social media and spreads like a virus, making it hard for people to find trustworthy, evidence-based guidance when they need it.

“Never before has there been a more urgent need for a coordinated, evidence-based approach to mitigating the harm caused by an infodemic and the spread of health misinformation. COVID-19 misinformation is harming communities and individuals,” says Dr Sylvie Briand, Director of the WHO Department of Global Infectious Hazard Preparedness.

The World EBHC Day campaign in 2021 responds to the WHO’s call for action. Guided by infodemiologist Gunther Eysenbach’s work on infodemic management and the WHO’s infodemic management framework, JBI, together with the organising partners of World EBHC Day, provide a platform for the global evidence community to share their experiences, stories and collective wisdom. 

WHO has produced a public health research agenda which recognises that infodemic management is an emerging and evolving field of research and practice, and that transdisciplinary synthesis is required to develop the field.

“The infodemic has been a major challenge to achieving an evidence-informed response to COVID-19,” says Dr Karla Soares-Weiser, Editor in Chief of the Cochrane Library. “This year’s World EBHC Day will be a timely opportunity for the evidence community to come together and explore our role in the responding to the current infodemic, as well as to consider how we can prepare for future infodemics.”

World EBHC Day calls on individuals and organisations in healthcare around the world to take action as we lead up to World EBHC Day on 20 October. Visit and contribute to a global response for infodemic management.

About World Evidence-Based Healthcare Day 2021

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

For more information, please visit the World EBHC Day website

Monday, July 26, 2021

Cochrane Skin seeks Research Fellow - Leicester, UK

Mon, 07/26/2021 - 19:20

Location: De Montfort University - Faculty of Health and Life Sciences. Leicester, UK
Salary: Part-time, 0.3 FTE, 11.1 hours per week
Contract type: 13 month fixed Term Contract
Closes: 8 August

The purpose of the role is to assist the principal investigator in all phases of the NIHR-funded study: ‘Cochrane Review of Interventions for Hyperhidrosis’. Key duties will include searching and selection of studies, data extraction, assessment of risk of bias, and data analysis and interpretation. You will also contribute to study outputs.

They are looking for someone with a PhD in Bioscience or Healthcare related discipline or equivalent experience. You will have experience of conducting high quality systematic reviews and meta-analysis. The ability to explain complex knowledge to a range of audiences is essential, along with excellent verbal and written communication skills. Good organisations skills and the ability to work well in a team are also required.

Monday, July 26, 2021 Category: Jobs

Expectations for RoB 2 revisited in light of comparison study

Fri, 07/23/2021 - 13:23

The existing expectations for RoB 2 that were set out in November 2020 have been revisited and kept in place after results of a Cochrane-funded study were released. The study was initiated to underpin methods policy and implementation plans with data about the usability of RoB 2 compared with the study-based Cochrane risk of bias tool for RCTs, and its impact on efficiency and review quality. The work was led by Bernd Richter and Bianca Hemmingsen from the Cochrane Metabolic and Endocrine Disorders Group and looked at inter-reliability across domains, time-taken to perform assessments, usability issues, and consequences for analysis results and interpretation.

The decision to keep the current expectations in place means that uptake of RoB 2 to assess randomised controlled trials is encouraged but there will still be the option to use the study-based Cochrane risk of bias tool, providing it is applied in a way that allows for differences in bias across outcomes to be captured. Reviews using RoB 2 should be prepared and edited in RevMan Web to take advantage of functionality that has been designed to store and present assessments clearly. Authors wishing to adopt RoB 2 after the protocol has been published, including switching to the tool for a review update, should make the decision with editorial staff and consult the resources available in the Starter Pack for reporting guidance.

Related links:

  • Full report of the study for more detail about how it was conducted and what it found
  • Blog post discussing implications of the results of the RoB 2 comparison study for authors and editors  
  • Blog post summarising important resources and practical guidance for RoB 2
Friday, July 23, 2021

Ivermectin for preventing and treating COVID-19

Thu, 07/22/2021 - 12:17
 Is ivermectin effective for COVID-19? Key messages

The authors of this Cochrane systematic review, published today by Cochrane Infectious Diseases Group, found no evidence to support the use of ivermectin for treating or preventing COVID-19 infection, but the evidence base is limited.

Evaluation of ivermectin is continuing in 31 ongoing studies; the authors will update this review with their results when they become available. 

Main authors of the review, Maria Popp and Stephanie Weibel said: “The lack of good quality evidence on efficacy and safety of ivermectin arises from a study pool that consists mainly of small, insufficiently powered RCTs with overall limited quality regarding study design, conduct, and reporting. Current evidence does not support using ivermectin for treating or preventing of COVID-19 unless they are part of well-designed randomized trials.”

What is ivermectin?

Ivermectin is a medicine used to treat parasites such as intestinal parasites in animals and scabies in humans. It is cheap and is widely used in regions of the world where parasitic infestations are common. It has few unwanted effects. 

Tests in the laboratory show ivermectin can slow the reproduction of the COVID-19 (SARS-CoV-2) virus but such effects would need major doses in humans.

Medical regulators have not approved ivermectin for COVID-19. It should only be used as part of well-designed studies (called randomized controlled trials) evaluating potential effects. 

What did the authors want to find out?

They wanted to know if ivermectin reduces death, illness, and length of infection in people with COVID-19, or  if it is useful in prevention of the disease. They included studies comparing the medicine to placebo (dummy treatment), no treatment, usual care, or treatments for COVID-19 that are known to work to some extent, such as remdesivir or dexamethasone. They excluded studies that compared ivermectin to other drugs that do not work, such as hydroxychloroquine, or that are not known to be effective against COVID-19.

They evaluated the effects of ivermectin in infected people on:

  • people dying;
  • whether people's COVID-19 symptoms got better or worse; 
  • unwanted effects;
  • hospital admission or time in hospital; 
  • viral clearance.

For prevention, they sought the effect on preventing COVID-19 and SARS-CoV-2 infection.

What did they do? 

The authors searched for randomized controlled trials that investigated ivermectin to prevent or treat COVID-19 in humans. People being treated with ivermectin had to have laboratory-test confirmed COVID-19 and be receiving treatment in hospital or as outpatients.

They compared and summarized the results of the studies and rated our confidence in the evidence, based on common criteria as to how reliable the evidence is.

What did they find? 

The authors found 14 studies with 1678 participants that investigated ivermectin compared to no treatment, placebo, or usual care.

For treatment, there were nine studies of people with moderate COVID-19 in hospital and four of outpatients with mild COVID-19. The studies used different doses of ivermectin and different durations of treatment.

One study investigated ivermectin to prevent COVID-19.

They also found 31 ongoing studies, and there are 18 studies still requiring clarification from the authors or not yet published.

Main results 

Treating people in hospital with COVID-19

The authors don't know whether ivermectin compared with placebo or usual care, 28 days after treatment:

  • leads to more or fewer deaths (2 studies, 185 people); 
  • worsens or improves patients' condition assessed by need for ventilation (2 studies, 185 people) or oxygen (1 study, 45 people); 
  • increases or reduces unwanted events (1 study, 152 people).

Seven days after treatment, we don't know if ivermectin:

  • increases or reduces negative COVID-19 tests (2 studies, 159 people).

Ivermectin compared to placebo or usual care may make little or no difference to improving patients' condition 28 days after treatment (1 study, 73 people) or to length of hospital stay (1 study, 45 people).

Treating outpatients with COVID-19

The author team don't know whether ivermectin compared with placebo or usual care:

  • leads to more or fewer deaths 28 days after treatment (2 studies, 422 people); 
  • worsens or improves patients' condition 14 days after treatment assessed by need for ventilation (1 study, 398 people); 
  • increases or reduces negative COVID-19 tests seven days after treatment (1 study, 24 people).

Ivermectin compared to placebo or usual care may make little or no difference to improving outpatients' condition 14 days after treatment (1 study, 398 people) or to the number of unwanted events 28 days after treatment (2 studies, 422 people).

No studies looked at hospital admissions in outpatients.

Preventing COVID-19

The authors don't know whether ivermectin leads to more or fewer deaths compared with no drug (1 study, 304 people); no participant died 28 days after the drug. This study reported results for development of COVID-19 symptoms (but not confirmed SARS-CoV-2 infection) and unwanted events, but in a way that we could not include in our analyses. This study did not look at hospital admissions.

Main results explained

Main authors of the review, Maria Popp and Stephanie Weibel said: “The lack of good quality evidence on efficacy and safety of ivermectin arises from a study pool that consists mainly of small, insufficiently powered RCTs with overall limited quality regarding study design, conduct, and reporting. Current evidence does not support using ivermectin for treating or preventing of COVID-19 unless they are part of well-designed randomized trials.”


What are the limitations of the evidence?

Confidence in the evidence is very low because the authors could only include 14 studies with few participants and few events, such as deaths or need for ventilation. The methods differed between studies, and they did not report everything they were interested in, such as quality of life. 

How up to date is this evidence?

The evidence is up to date to 26 May 2021.

What’s next?

Evaluation of ivermectin is continuing in 31 ongoing studies; the authors will update this review with their results when they become available. 

Wednesday, July 28, 2021

Cochrane review informs WHO drowning prevention guideline

Wed, 07/21/2021 - 18:32

The World Health Organization (WHO) has issued a new recommendations which is supported by evidence from a Cochrane Public Health review. 

From this year on, 25 July marks the new UN-recognised "World Drowning Prevention Day". This global advocacy event serves as an opportunity to highlight the tragic and profound impact of drowning on families and communities and offer life-saving solutions to prevent it.

On World Drowning Prevention Day 2021, the World Health Organization launched its guideline on the provision of day-care and basic swimming and water safety skills training to prevent drowning. Cochrane Public Health and  First Aid and its initiator the Centre for Evidence-Based Practice feel proud to have developed 2 systematic reviews to inform this guideline.

Cochrane has been a non-governmental organization in official relations with WHO since 2011, and a major aspect of this partnership is supporting WHO’s global health guidelines with relevant evidence synthesis.

Cochrane review on day care provision

The WHO guideline contains evidence from the review 'Day care as a strategy for drowning prevention in children under 6 years of age in low‐ and middle‐income countries'.  Cochrane Public Health group have joined focuses with Cochrane First Aid to ensure a successful dissemination of review finding. 





WHO guideline recommendation on daycare provision

Based on the review's findings and the overall balance between the desirable and undesirable effects of day care provision, the WHO guideline recommends day care for children under 6 years of age as a drowning prevention strategy in countries with a high burden of drowning (strong recommendation; moderate-certainty evidence).

These day care programs must be developed and regulated with a main focus on quality (e.g. safety and well-being of children, involving parents, addressing nutritional needs) and other aspects (e.g. equitable staff treatment, open during periods of high drowning risk for drowning, measures to minimize the risk of spread of infectious diseases). 

Cochrane is extremely proud of this valuable work and our continued partnership with WHO and between Cochrane Groups.

Monday, July 26, 2021 Category: The difference we make

Four new WHO recommendations supported by Cochrane Pregnancy and Childbirth reviews and ‘living guideline’ approach

Wed, 07/21/2021 - 14:27

The World Health Organization (WHO) has issued four new recommendations which are supported by evidence from Cochrane Pregnancy and Childbirth reviews.

Cochrane has been a non-governmental organization in official relations with WHO since 2011, and a major aspect of this partnership is supporting WHO’s global health guidelines with relevant evidence synthesis.

The Cochrane Pregnancy and Childbirth Group has a long-standing collaboration with WHO on the development and updating of Cochrane reviews that inform WHO’s guidelines on global maternal and perinatal health.

This relationship has led to the development of a joint ‘living guidelines’ system. The approach uses a combination of ongoing literature surveillance to inform prioritization, rapid appraisal of the potential impacts of new evidence on recommendations and accelerated updating of high-priority Cochrane systematic reviews for key questions.

The four new WHO recommendations, which relate to the prevention and treatment of maternal peripartum infections, were developed using this approach.

Read the new WHO recommendations:

Cochrane is extremely proud of this valuable work and our continued partnership with WHO. It ensures that the latest evidence in maternal and perinatal health can be translated into practice as quickly as possible. 

Wednesday, July 21, 2021 Category: The difference we make

Author interview: Diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment

Wed, 07/21/2021 - 09:52

Recently Cochrane Dementia and Cognitive Improvement published 'Diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment.' We spoke with Dr Jenny McCleery, one of the authors of this Cochrane review, a Consultant Psychiatrist at Oxford Health NHS Foundation Trust, and the Joint Coordinating Editor, of Cochrane Dementia and Cognitive Improvement Group. Find out about the findings, how it came about, and how the pandemic prompted this review.

Can you tell us about this Cochrane Review? We'd love to know how it came about and what drew to you the topic. 
We chose to write this review when we did because of the COVID-19 pandemic. All the authors work in NHS clinical services. Some of my regular work is in a community memory clinic, where we assess older people with suspected dementia. Of course, not every patient gets a diagnosis, but most commonly we diagnose dementia or mild cognitive impairment (MCI), which is a less severe condition in which the patient has some problems with thinking and/or remembering, but can still manage all their daily activities independently. In our service, a patient usually has some investigations before the appointment (blood tests and often a brain scan), and then spends 1-2 hours in clinic being interviewed and examined before a doctor makes a diagnosis.
Once the pandemic hit, there was an immediate suspension of all non-urgent face-to-face contacts and memory clinics were left scrabbling to find alternative ways to keep their services going. One way to do this was to offer telehealth assessments, that is assessments conducted using telephone or videoconferencing systems where the patient and the doctor making the diagnosis did not meet in person. Although it was clear that this would not be an ideal solution for many older people with suspected dementia, some patients were willing to try this approach.
This brought up lots of questions. One of these was whether patients could be confident that we would be able to make accurate diagnoses of dementia or mild cognitive impairment using telehealth methods. We knew there was some literature about this, mainly from higher income countries where there is an interest in providing services to remote and rural areas. We thought it would be important to look at the work that had been done in those areas to see what was known about accuracy of telehealth diagnoses.
Although we were motivated chiefly by the pandemic, there are other very good reasons to be interested in the use of telemedicine in dementia services. Worldwide, a large majority of people with dementia have not had a formal diagnosis. This affects not only their own and their families’ knowledge about the cause of their symptoms, but also their access to support services and treatments. It also means that governments and health and social care providers lack essential information to plan services for their populations. The World Health Organization (WHO) has set a target that by 2025 at least 50% of the estimated number of people with dementia in 50% of countries should have had a diagnosis. This target will be challenging in many countries, and innovative ways to increase access to assessment will be needed, particularly for older people living outside urban centres. Telehealth might be one part of a solution.

What is included in the review?
We looked for studies in which participants had two assessments for dementia within four weeks of each other - one assessment using telehealth methods and one standard face-to-face assessment. The face-to-face assessment was the ‘reference standard’, that is, it was assumed to give the correct result, and we then looked to see how well the telehealth assessment (the index test) agreed with it. These kinds of studies are known as cross-sectional diagnostic test accuracy studies.
We knew that in remote and rural services, the telehealth models used are not necessarily very ‘pure’. Even if the specialist making the diagnosis does not meet the patient in person, it is quite common for local healthcare professionals, e.g. nurses, to meet the patient to gather some information or do some of the examination in advance. Although these models might not be very useful in a pandemic situation, we included them because of the wider importance of telemedicine for dementia care in future.
We only found three studies with 136 participants to include in the review. Two studies (20 and 100 participants) took place in community settings in Australia and one study (16 participants) was conducted in veterans' care homes in the USA. All the telehealth assessments were done using videoconferencing systems. Only the smaller Australian study (20 participants) used a pure telehealth model in which all aspects of the assessment were done remotely. In the other two studies, quite a lot of information was gathered in person by nurses and used in both diagnostic assessments; this could make it more likely for the researchers to find close agreement between the in-person and telehealth diagnoses.

How can people with dementia, their carers and clinicians use the review to help them with their decision making?
The conclusions we could draw were limited by the very small amount of evidence and the application of our results to the pandemic situation was limited by the type of telehealth model used in the included studies.
In as far as they went, the results were reassuring for the accuracy of telehealth assessment. We found that telehealth assessment correctly identified 80% to 100% of the people who were diagnosed with dementia at face-to-face assessment and also correctly identified 80% to 100% of people who did not have dementia. Only one study (100 participants) attempted to diagnose MCI. In this study, 71% of participants who had MCI were correctly identified using telehealth assessment, as were 97% of those who had any cognitive diagnosis (either MCI or dementia), but only 22% of those who had no cognitive diagnosis at face-to-face assessment. However, the latter result was especially uncertain because there were so few patients in this category.

It is important to note that diagnoses of dementia and MCI made by two specialists seeing patients face-to-face will not show 100% agreement. Therefore, perfect agreement between telehealth and face-to-face assessments cannot be expected. The larger Australian study was interesting because it also included a group who had two face-to-face assessments; the authors found that agreement between telehealth and face-to-face assessments was no worse than agreement between two face-to-face assessments.
Therefore, although there was less evidence than we would like to have found, we did not find any reason to think that dementia diagnoses made by clinicians using videoconference assessments were likely to be inaccurate.

What would you like to see happen next to build on this study?
There are many more questions to be answered. We have not touched so far on the diagnosis of different subtypes of dementia, which is something else clinicians in memory clinics are usually trying to achieve. Although we intended to study accuracy of subtype diagnosis, we did not find any data on this at all. That would be something very important to study if telehealth were to remain in widespread use.
A few established telehealth dementia services, again mainly in remote and rural areas, have published data on the acceptability of the telehealth model to their populations. The factors affecting acceptability are likely to vary a lot from place to place, so local research on acceptability, equity and barriers to use is really important to inform service developments.
There is also clearly a need to compare different telehealth models on accuracy, acceptability, cost effectiveness and sustainability measures.
Although we were only looking at the accuracy of diagnosis in this review, patients and carers are of course also interested in the quality of ongoing support after a dementia diagnosis. Whether telehealth support services are effective is another whole area for interesting research.

Thursday, July 22, 2021