A new Cochrane Library editorial has published titled 'Low sodium salt substitutes: a tool for sodium reduction and cardiovascular health.'

The World Health Organization has a target of reducing global population salt intake by 30% by 2025.  This has made Cochrane’s new systematic review on the efficacy and safety of low sodium salt substitutes (LSSS) timely.  The Cochrane systematic review and meta-analysis examines the evidence regarding the use of LSSS on cardiovascular health in adults and children and included blood pressure as a primary outcome.  

Rachael McLean, from the Department of Preventive and Social Medicine, University of Otago, New Zealand, discusses the latest Cochrane evidence and how it can support policymakers in their efforts to reduce sodium intake and how applicable the evidence may be in different settings and populations. 

Rachael McLean explains:

“In some countries, more than 50% of the salt intake comes from salt used in the home. Cochrane’s review of the evidence on low sodium salt substitutes is valuable for policy makers looking to make substantial impacts for cardiovascular health and in directing researchers where further studies are urgently needed.”

• Read the Cochrane Library Editorial 

Women around the world should be able to access the best medical treatments that help to delay preterm births and improve neonatal outcomes, updated Cochrane network meta-analysis suggests.

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

A new Cochrane Pregnancy and Childbirth paper published in the Cochrane Library looked at data from 122 clinical trials to create a league table of drugs that delay birth, called tocolytics, about their effectiveness and side effects. Researchers from the University of Birmingham and World Health Organization reviewed 122 randomised trials, published between 1966 and 2021, involving 13,697 women and conducted in 39 countries including high, middle and low-income states.

Women benefitted from all preterm delay treatments included in the meta-analysis of studies, although the research team noted that the effectiveness of different drugs was less clear in some of the studies considered. The team also looked at the side effects of different drugs and combinations, including the likelihood of having to stop treatment.

The team have bought together the evidence on the benefits as well as the harms of these treatments (compared to no treatment or placebo), to arm clinicians and policy makers around the world with the information to decide upon the best treatment for the women in their care in their specific setting.

Dr Amie Wilson, Research Fellow Global Maternal Health at the University of Birmingham said:

The findings show that the benefits of these drugs outweigh any risks associated with unwanted side effects. These treatments are leading to a significant reduction in the number of deadly preterm births, and we now need to further understand the effectiveness of tocolytics for specific groups depending on pregnancy length.

Our previous research has led to the improvement of guidelines for use of tocolysis drug use to delay preterm birth in the UK. Knowing that this paper helped to inform the forthcoming recommendations of the World Health Organization on the use of tocolytics, we hope that many more women around the globe will have access to these drugs, and have healthier births.

Dr Victoria Hodgetts Morton, NIHR Clinical Lecturer in Obstetrics at the University of Birmingham and co-author of the paper said:

Preterm birth is the most common reason why a newborn baby may die, and the leading cause of death in children under five years of age.

Tocolytics aim to delay preterm birth and allow time for the women to receive medicines that can help with baby's breathing and feeding if born preterm, and medicines that lower the chance of cerebral palsy of the infant. Crucially, a short delay in preterm birth can enable women to reach specialist care.

Full citation: Wilson A, Hodgetts-Morton VA, Marson EJ, Markland AD, Larkai E, Papadopoulou A, Coomarasamy A, Tobias A, Chou D, Oladapo OT, Price MJ, Morris K, Gallos ID. Tocolytics for delaying preterm birth: a network meta-analysis (0924). Cochrane Database of Systematic Reviews 2022, Issue 8. Art. No.: CD014978. DOI: 10.1002/14651858.CD014978.pub2

• Visit the Cochrane Pregnancy and Childbirth website
• Read the full Cochrane Review
• Learn more about Cochrane and Systematic Reviews

 A new Cochrane Library Special Collection provides an overview of Cochrane Reviews that summarize the potential benefits and harms of deprescribing specific medications and help to inform how to implement deprescribing across different settings and populations.

This collection of reviews highlight that deprescribing is likely feasible and safe and can lead to benefits in prescribing and clinical outcomes. However, they also highlight significant gaps in the literature and methodological challenges to both conducting deprescribing studies and systematic reviews of deprescribing.

• View the Cochrane Library Special Collection
• Visit the Cochrane Sustainable Healthcare website
• Free Webinar: From Evidence of Overuse to De-implementation

Catherine joins Cochrane from The Seafarers’ Charity where she held the position of CEO.

Governing Board Co-Chairs, Tracey Howe and Catherine Marshall said: "We are delighted to welcome Catherine to Cochrane. Catherine is a proven Chief Executive with an exceptional record leading non-profit organisations. She brings expertise in strategic planning, change management, and communications under pinned by a global perspective. Catherine is well positioned to partner with the Editor-in-Chief, Karla Soares-Weiser, to lead Cochrane as we drive an exciting programme of delivering trusted evidence, promoting informed decisions, and better health.”

Prior to her role at The Seafarers’ Charity, Catherine was acting Chief Operating Officer and Director of Communications and Change Management at international public health research organisation, icddrb, in Dhaka, Bangladesh. Between 2008-2015 Catherine held various senior management roles at the Army Families Federation, including three years as Chief Executive.

Catherine Spencer said, “Like all organisations post-Covid, we have challenges to deal with, but I see so much opportunity for Cochrane in the future. I look forward to what will inevitably be stimulating conversations with the Cochrane Community about what a thriving future Cochrane looks like and what we need to do to achieve that as we build a long-term strategy together.

I spent three and a half years working at icddr,b, in Dhaka, Bangladesh - a large public health research organisation, that at the time was facing enormous financial and structural challenge. Working as part of the Senior Leadership Team, and very closely with the Executive Director and Board, the organization was rejuvenated, meaning its essential public health research could continue. Thus, I come to Cochrane familiar with an organisation managing change and I look forward to working with you, collaboratively to steer Cochrane to success.”

Catherine will meet with the Cochrane Community in two introductory webinars to accommodate different time zones. Invites will be sent directly to Community Members via email.

• Read Catherine's full bio

Specifications: Full Time (Permanent)
Salary: circa £40,000 per annum
Location: Ideally based in the UK, Germany or Denmark. Candidates from the rest of the world will be considered; however, Cochrane’s Central Executive Team is only able to offer consultancy contracts outside these countries (1-year fixed-term contracts)
Application Closing Date: 7th September 2022

Cochrane has established a centrally-resourced Editorial Service to support the efficient and timely publication of high-quality systematic reviews in the Cochrane Library. The reviews that are published through the Central Editorial Service address some of the research questions considered to be the most important to decision makers.

Reporting to the Executive Editor of the Central Editorial Service, the Managing Editor will manage the editorial process of protocols and reviews submitted to the Central Editorial Service. The role-holder should be alert to the demands of delivering high-quality review content for publication in a timely fashion, and work to ensure that deadlines can be met.   

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information. An understanding of Cochrane’s work and health research more generally is an advantage, but not essential.

The majority of Cochrane Central Executive staff are located in London, UK, however flexible locations are possible for the right candidate. Please note, however, that we are only able to offer consultancy contracts outside of the UK, Germany or Denmark.

We will consider extended notice periods if required for applicants who wish to honour existing contracts. We fully support remote and flexible working arrangements. 

How to apply

• For further information on the role and how to apply, please click here. 
• The deadline to receive your application is by 7th September. 
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
• Note that we will assess applications as they are received, and therefore may fill the post before the deadline.
• Read our Recruitment Privacy Statement

Specifications: Permanent
Salary: £45,000 per annum
Location: UK
Application Closing Date:  17 July 2022

To provide strategic support to deliver cross-departmental objectives and targets by:

• Working closely with the Editorial Product Lead and the methods community to deliver on activities so Cochrane can produce and publish a variety of evidence synthesis types and other content that align with Cochrane’s strategy for review production and meet Cochrane’s mission.
• Coordinating the development of best practice resources for Cochrane’s methodological standards.
• Leading on editorial and methods projects to develop Cochrane’s platforms and processes.
• Being the main point of contact for the methods community and engaging with Methods Groups, the Methods Executive and Methods Network to facilitate their involvement with Cochrane.

The Methods Implementation Editor will provide strategic editorial and methods support to departments across Cochrane and the methods community to enable efficient, high-quality review production for a variety of types of evidence syntheses and methods. Overall, this role will contribute to streamlining and simplifying review production and publication to support Cochrane’s efficiency and sustainability as an organisation.

How to apply

• For further information on the role and how to apply, please click here.
• The deadline to receive your application is by 17 July 2022.
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
• Note that we will assess applications as they are received, and therefore may fill the post before the deadline.
• Read our Recruitment Privacy Statement

Cochrane Sustainable Healthcare and Choosing Wisely Canada invite you to join a free live webinar where leading experts discuss the challenges of abandoning existing low-value care practices, which may not be beneficial or even cause harm to patients. Ideal for healthcare professionals, guideline developers, and policy makers.

Experts will share experiences on how to address the urgency of finding out when and how de-implementation, de-intensification of medical interventions, and diagnostics should be undertaken, without causing harm to patients, de-professionalizing clinicians, or counteracting shared decision-making processes.

 10 Oct 2022
4:00pm - 5:30pm CET (View in your time zone) 
View agenda
Register for free

Speakers:

• Dr. Minna Johansson, Cochrane Sustainable Healthcare  and Cochrane Sweden
• Dr. Wendy Levinson, Choosing Wisely Canada
• Dr. Jeremy Grimshaw, Choosing Wisely Canada
• Dr. Nicolaas Sieds Klazinga, OECD Health Care Quality Indicator

Specifications: 12 months Fixed term/Consultancy contract dependant on location
Salary: £42,000 per annum
Location: Flexible
Application Closing Date:  12 August 2022

Cochrane requires a talented internal communications specialist to contribute to the development and implementation of a complex, organization-wide transformation and change management programme to be rolled out over the next 12 months. The key focus of this varied role will be creating and delivering a strategic internal communications plan to support our ongoing transformation programmes. This will involve creating and disseminating clear, informative and engaging content (including online news and social media posts, videos and e-newsletters) for the Cochrane community and the many diverse audiences within it.

Cochrane manages a large number of websites and social media channels. The organisation also uses a digital marketing database for targeted mailings and newsletters; and can segment audiences to ensure effective communication.

This role would suit an individual who embraces change; whilst understanding how to convey key messages to stakeholder groups impacted by this change.

Cochrane is a global network of more than 115,000 people, and our internal community accounts for around 1,000 of those people. This role will need to work effectively across the internal community network, demonstrating excellent cross-cultural working. 

How to apply

• For further information on the role and how to apply, please click here. 
• The deadline to receive your application is by 12 August 2022. 
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
• Note that we will assess applications as they are received, and therefore may fill the post before the deadline.
• Read our Recruitment Privacy Statement 

Is ivermectin effective for COVID‐19? Updated Cochrane review 'Ivermectin for preventing and treating COVID‐19'

Key messages

• We found no evidence to support the use of ivermectin for treating COVID‐19 or preventing SARS‐CoV‐2 infection. The evidence base improved slightly in this update, but is still limited.
• Evaluation of ivermectin is continuing in 31 ongoing trials, and we will update this review again when their results become available.  

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

Medical regulators have not approved ivermectin for COVID‐19.

What did we want to find out?
We wanted to update our knowledge of whether ivermectin reduces death, illness, and length of infection in people with COVID‐19, or is useful in prevention of the infection. We included trials comparing the medicine to placebo (dummy treatment), usual care, or treatments for COVID‐19 that are known to work to some extent, such as dexamethasone. We excluded trials comparing ivermectin to other medicines that do not work, like hydroxychloroquine, or whose effectiveness against COVID‐19 is uncertain.

We evaluated the effects of ivermectin in infected people on:

• people dying;
• whether people's COVID‐19 got better or worse;
• quality of life;
• serious and non‐serious unwanted effects;
• viral clearance.

For prevention, we sought the effect on preventing SARS‐CoV‐2 infection and COVID‐19 disease.

What did we do?
We searched for randomized controlled trials that investigated ivermectin to prevent or treat COVID‐19. People treated in hospital or as outpatients had to have laboratory‐confirmed COVID‐19.

In this update, we also investigated the trustworthiness of the trials and only included them if they fulfilled clear ethical and scientific criteria.

We compared and summarized the results of the trials and rated our confidence in the evidence, based on common criteria such as trial methods and sizes.

What did we find?
We excluded seven of the 14 trials included in the previous review as these trials did not fulfil the expected ethical and scientific criteria. Together with four new trials, we included 11 trials with 3409 participants that investigated ivermectin combined with any usual care compared to the same usual care or placebo.

For treatment, there were five trials of people in hospital with moderate COVID‐19 and six trials of outpatients with mild COVID‐19. The trials used different doses of ivermectin and different durations of treatment.  

No trial investigated ivermectin to prevent SARS‐CoV‐2 infection.

We also found 31 ongoing trials, and an additional 28 trials still requiring clarification from the authors or not yet published.

Main results  

Treating people in hospital with COVID‐19

We do not know whether ivermectin compared with placebo or usual care 28 days after treatment:

• leads to more or fewer deaths (3 trials, 230 people);
• worsens or improves patients' condition, assessed by need for ventilation or death (2 trials, 118 people);
• increases or reduces serious unwanted events (2 trials, 197 people).

Ivermectin compared with placebo or usual care 28 days after treatment, may make little or no difference to:

• improving patients' condition, assessed by discharge from hospital (1 trial, 73 people);
• non‐serious unwanted events (3 trials, 228 participants). 

Seven days after treatment, ivermectin may make little or no difference to reduction of negative COVID‐19 tests (3 trials, 231 participants) compared with placebo or usual care.

Treating outpatients with COVID‐19
Ivermectin compared with placebo or usual care 28 days after treatment, probably makes little or no difference to people dying (6 trials, 2860 people).

Ivermectin compared with placebo or usual care 28 days after treatment, makes little or no difference to quality of life (1 trial, 1358 people).

Ivermectin compared with placebo or usual care 28 days after treatment, may make little or no difference to:

• worsening patients' condition, assessed by admission to hospital or death (2 trials, 590 people);
• serious unwanted events (5 trials, 1502 people);
• non‐serious unwanted events (5 trials, 1502 participants);
• improving people's COVID‐19 symptoms in the 14 days after treatment (2 trials, 478 people);
• number of people with negative COVID‐19 tests 7 days after treatment (2 trials, 331 people).

Review authors, Dr Maria Popp and Dr Stephanie Weibel said:

“Overall, the outlook for ivermectin’s use to treat or prevent SARS-CoV-2 is poor. While laboratory results showed some promise, real-life outcomes suggest no or very little impact on mortality rates, illness, and length of infection.”

What are the limitations of the evidence?
Our confidence in the evidence, especially for outpatients, improved since the last review version, because we could look at more participants included in high‐quality trials. Although we are quite certain regarding our results on risk of people dying and quality of life, the confidence in the evidence is still low for many other outpatient and inpatient outcomes because there were only few events measured. The methods differed between trials, and they did not report everything we were interested in, such as relevant outcomes.

How up to date is this evidence?
The systematic literature search is up to date to 16 December 2021. Additionally, we included trials with > 1000 participants up to April 2022.

• Link to updated review
• Link to Liverpool School of Tropical Medicine news item