A new Cochrane review has found that taking zinc may help to reduce the duration of common cold symptoms by about two days, but the evidence is not conclusive and potential benefits must be balanced against side-effects. 

Since the 1980s, zinc products have been marketed as treatments for the common cold and are particularly popular in the USA. Zinc is an essential mineral naturally found in many foods and plays a role in immune function. Most people in high-income countries get enough zinc through their diets, although aging and some chronic diseases may lead to deficiency. 

The theory behind zinc-based lozenges, sprays and syrups is that the zinc may interfere with viral replication when it comes into contact with viral particles in the nose, mouth and throat. Zinc has been shown to interfere with viral replication in petri dishes and mice, although this alone doesn't tell us whether something will work in real people. 

To test if zinc is useful in preventing or treating a cold, a team of researchers looked at 19 human trials examining zinc as a treatment and 15 as a preventative measure. They identified a lot of variation between the studies in how zinc was administered, how much was given, how they defined a ‘cold’ and what they measured. 

Eight studies with 972 participants investigated zinc as a treatment to reduce cold duration. Combining the results of these studies yielded low-certainty evidence that it may help to reduce duration by around two days, down from an average week-long duration in the groups who received placebo.  

The review found no strong evidence to conclude that zinc treatment impacts the severity of cold symptoms. The prevention studies showed no clear evidence of benefit from taking zinc before the onset of a cold; those taking zinc preventatively had similar outcomes to those who didn’t. 

Common side-effects of zinc reported in the trials included bowel problems, nausea and unpleasant taste. There was no clear evidence of more serious side-effects directly resultant from zinc. 

“People considering zinc to treat a cold should be aware of the limited evidence base and possible side-effects,” says Assistant Professor Daryl Nault of Maryland University of Integrative Health, first author of the review. “Ultimately, it’s up to the individual to decide whether the risk of potential unpleasant side-effects is worth the benefit of potentially shortening their illness by a few days. The best advice remains to consult your physician if you’re feeling unwell and inform them if you use any supplements. While there have been many trials investigating zinc, the approaches vary, so it is difficult to draw conclusions with certainty.” 

The trials included in the review varied in many ways including the type of zinc, the dose of zinc given, whether it was given as a lozenge or nasal spray, and how the outcomes were reported and measured. Some trials measured for a fixed time window and asked participants if they still had a cold at the end. Others measured the time between symptoms starting and resolving, although this was defined slightly differently by each study. Few studies monitored the status of individual symptoms, such as sore throat, cough or fever, so there was insufficient evidence to draw any reliable conclusions about specific symptoms. 

“The evidence on zinc is far from settled: we need more research before we can be confident in its effects,” says Assistant Professor Susan Wieland of the University of Maryland School of Medicine, senior author of the review. “Future studies should adopt standardized methods for administering and reporting treatments and defining and reporting outcomes. Additional studies focusing on the most promising types and doses of zinc products and using appropriate statistical methods to assess outcomes that are important to patients will enable us to understand whether zinc may have a place in treatment of the common cold.” 

• Read the full Cochrane review and plain language summary in the Cochrane Library 
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Specifications: Permanent – Full Time (1.0 FTE.)
Salary:   circa £35,000 per Annum
Location: (Remote – Flexible) Ideally based in the UK, Germany or Denmark. Candidates anywhere from the world will be considered; however, Cochrane’s Central Executive Team is only able to offer consultancy contracts outside these countries for 1-Year.
Closing date: 21 April 2024

Cochrane is an international charity. For 30 years we have responded to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesising research findings and our work has been recognised as the international gold standard for high quality, trusted information.

Cochrane's strength is in its collaborative, global community. We have 110,000+ members and supporters around the world. Though we are spread out across the globe, our shared passion for health evidence unites us. Our Central Executive Team supports this work and is divided into four directorates: Evidence Production and Methods, Publishing and Technology, Development, and Finance and Corporate Services.

To help maintain and evolve Cochrane’s cloud hosting and application deployment infrastructure, ensure applications’ dependencies are kept current (both independently and in collaboration with development teams), and promote operational awareness across the infrastructure. This role works across development and operations (DevOps).

Don’t have every single qualification? We know that some people are less likely to apply for a job unless they are a perfect match. At Cochrane, we’re not looking for “perfect matches.” We’re looking to welcome people to our diverse, inclusive, and passionate workplace. So, if you’re excited about this role but don’t have every single qualification, we encourage you to apply anyway. Whether it’s this role or another one, you may be just the right candidate.

Our organization is built on four core values: Collaboration: Underpins everything we do, locally and globally. Relevant: The right evidence at the right time in the right format. Integrity: Independent and transparent. Quality: Reviewing and improving what we do, maintaining rigour and trust.

You can expect:

• An opportunity to truly impact health globally.
• A flexible work environment
• A comprehensive onboarding experiences.
• An environment where people feel welcome, heard, and included, regardless of their differences.

Cochrane welcomes applications from a wide range of perspectives, experiences, locations, and backgrounds; diversity, equity and inclusion are key to our values.

How to apply

• For further information on the role and how to apply
• The deadline to receive your application is 21 April 2024.
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
• Read our Recruitment Privacy Statement

We are thrilled to announce the publication of a new editorial titled "Unlocking the Power of Global Collaboration: Building a Stronger Evidence Ecosystem Together," authored by Prof Zoe Jordan of JBI, Dr Vivian Welch of The Campbell Collaboration, and Dr Karla Soares-Weiser of Cochrane. This editorial is now available simultaneously in JBI Evidence Synthesis, Campbell Systematic Reviews, and the Cochrane Database of Systematic Reviews. It underscores the urgent need for collaborative efforts to harness the potential of evidence synthesis on a global scale. This collaborative endeavour reflects the shared commitment of the three organisations to foster cooperation, aiming to enhance both health outcomes and policy efficacy worldwide.

The editorial highlights the pivotal role of collaboration in addressing contemporary global challenges, emphasizing the collective commitment of JBI, The Campbell Collaboration, and Cochrane to foster cooperation for enhanced health outcomes and policy efficacy worldwide. Dr. Karla Soares-Weiser said: "This co-publication marks a significant milestone for all three of our organizations and reaffirms our dedication to collaboration. Our respective communities are profoundly collaborative and communicative within their domains, and we'd now like to catalyze further collaboration between and across them. We're particularly excited about the upcoming Global Evidence Summit, where leaders in evidence synthesis and evidence-based practice, including Cochrane, JBI, Guidelines International Network (GIN), and The Campbell Collaboration, will convene to share best practice and promote cross-disciplinary working."

Scheduled for September 2024, the Global Evidence Summit represents a unique opportunity for professionals across various sectors to engage in discussions about evidence production, summarization, and dissemination, informing policy and practice. Dr. Soares-Weiser emphasized the importance of this event: "The GES serves as a platform for knowledge exchange and collaboration, crucial for addressing global challenges in health, education, social justice, and the environment." As the editorial advocates for a shift towards enhanced collaboration, the Global Evidence Summit sets the stage for meaningful dialogue and action.

• Learn more about the Global Evidence Summit
• Read the editorial

Jordan Z, Welch V, Soares-Weiser K. Unlocking the power of global collaboration: building a stronger evidence ecosystem together. Cochrane Database of Systematic Reviews 2024, Issue 4. Art. No.: ED000166. DOI: 10.1002/14651858.ED000166.

Door-to-door tuberculosis (TB) screening and contact tracing can improve diagnosis rates, but must be paired with effective follow-up care to be successful, a new Cochrane review has found.

Active case finding (ACF) seeks to improve diagnosis rates in people living in communities who may not otherwise present to health facilities, helping them access treatment and reduce onward transmission.

Despite being a key strategy of most TB strategies globally, there is often little consideration of how these programmes are experienced by communities. This is essential in designing appropriate and effective services.

Published ahead of World TB Day (24 March), a new review published by Cochrane Infectious Diseases, based at Liverpool School of Tropical Medicine, looked at studies of community experiences towards ACF programmes for TB in any endemic low- or middle-income country. This was a qualitative evidence synthesis that looked at the evidence from 45 studies. 

Senior author and Cochrane Infectious Diseases Editor, Professor Sandy Oliver,  said, “The power of qualitative syntheses like these is in their ability to capture rich information from various contexts to develop a deep understanding of how policies play out in the real world – how services deliver them, how communities receive them or avoid them, what might make them work a little better, and why”.

The review authors found that ACF improves access to diagnosis for many, but does little for those in financial need to continue care. People may also experience stigma in relation to screening.

It was also shown that ACF can create expectations for follow-up care that health systems may not be able to meet, as well as health workers finding it difficult to implement.

This Cochrane Review will help to better understand policy in action and the perceived benefit relative to the harm of ACF.

Lead author Melissa Taylor said: “Active case finding brings diagnosis to many of those who may otherwise not have received it. However, our review demonstrates it is essential that active case finding is linked to well-resourced follow up services and wider health system strengthening.”

• Read the full Cochrane review and plain language summary
• Learn more about this review on the Cochrane Infectious Diseases website

Taylor M, Medley N, van Wyk SS, Oliver S. Community views on active case finding for tuberculosis in low‐ and middle‐income countries: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD014756. DOI: 10.1002/14651858.CD014756.pub2

In this blog for colorectal surgeons and health professionals involved in stoma reversals, Dr Stina Öberg, Dr Siv Fonnes, and Professor Jacob Rosenberg from the Cochrane Colorectal Group discuss new practice-changing Cochrane evidence, showing that a simple change of suture technique likely results in a large reduction in surgical site infections in people undergoing stoma reversal.

Take-home points

• The stoma closure site can be considered a clean-contaminated wound, and many patients develop a surgical site infection after having a temporary ileostomy or colostomy reversed.
• Surgeons often use linear skin closure after stoma reversal. In theory, a clean-contaminated wound can benefit from drainage, which is achieved by using the purse-string skin closure technique.
• A new Cochrane Review has demonstrated that the purse-string skin closure technique likely results in a large reduction in surgical site infections after stoma reversal compared with linear skin closure.
• This simple and inexpensive change of practice may also improve patient satisfaction slightly. Even though the evidence is very uncertain, there seems to be no difference in incisional hernias.

Can surgeons improve their skin closure technique after stoma reversal? Yes - in a straightforward way! Researchers have found clinically important evidence in a new Cochrane review, showing that a simple change of suture technique likely results in a large reduction of surgical site infections in people undergoing stoma reversal. This blog presents the key results from this Cochrane review.

Skin closure after stoma reversal
Temporary stomas are created to protect distal bowel segments. At the time of stoma reversal, the last step is to close the skin. Due to the proximity to intestinal content, the stoma closure site should be considered a clean-contaminated wound. This could also explain why surgical site infections are common after stoma reversal, occurring in up to 40% of patients. When a wound is potentially contaminated, it will in theory benefit from free drainage.

Linear skin closure
Most surgeons use linear (transverse) skin closure despite the possible contamination of the wound at the stoma reversal site. Linear skin closure provides poor or no wound drainage and is theoretically a poor choice for a clean-contaminated wound. The stoma reversal wound is often close to a circular shape, and there is an alternative skin closure technique that at the same time provides drainage - the purse-string technique.

Purse-string skin closure
The purse-string skin closure technique can be used for circular or ellipse-formed wounds. The technique is performed by using intradermal sutures that are drawn together like an old-fashioned drawstring purse (see illustration at the top of the page), leaving a small opening in the centre. The theoretical advantage of using purse-string skin closure for a clean-contaminated wound is that it provides free drainage. This advantage could lower the risk of developing surgical site infections compared with linear skin closure. A lower surgical site infection risk could also result in a better cosmetic result, a higher patient satisfaction, and fewer incisional hernias.

What are the benefits of the purse-string skin closure?
In the Cochrane review comparing purse-string skin closure versus linear skin closure in people undergoing stoma reversal, surgical site infection was assessed in nine randomised controlled trials including almost 800 patients. The purse-string technique likely results in a large reduction in surgical site infections compared with linear skin closure. The anticipated risk within 30 days after linear closure was 243 surgical site infections per 1000 patients versus 52 (95% confidence interval 28 to 85) per 1000 patients after purse-string skin closure.

Purse-string closure may also have other advantages over linear closure. Patients who received the purse-string skin closure seemed to be slightly more satisfied six and twelve months after surgery: the anticipated effect in two randomised controlled trials was 885 satisfied or very satisfied patients per 1000 patients having linear skin closure versus 994 (95% confidence interval 894 to 1000) per 1000 patients having purse-string skin closure.

Finally, a reduced risk of surgical site infections could reduce the risk of incisional hernias. This outcome was reported by four randomised controlled trials with nearly 300 patients followed between three and twelve months, showing an anticipated risk of 55 incisional hernias per 1000 patients after linear skin closure versus 29 (95% confidence interval 4 to 177) per 1000 patients having purse-string skin closure. Even though the purse-string skin closure theoretically could lower the risk of incisional hernias, this was not shown, and there seems to be little to no difference in the risk of developing incisional hernias regardless of the skin closure technique used. However, the evidence is very uncertain, and further randomised controlled trials with longer follow-up might alter this result.

What are the benefits of linear skin closure?
The Cochrane review showed no advantage of using linear skin closure compared with purse-string skin closure in patients undergoing stoma reversal.

What are the risks of the purse-string skin closure?
The Cochrane review suggested that there was no evidence of an increased risk when patients received the purse-string technique compared with linear skin closure.

Pros and cons of purse-string versus linear skin closure
To summarise:

The benefits of using purse-string skin closure:

• likely results in a large reduction in surgical site infections
• may improve patient satisfaction slightly

The benefits of using linear skin closure:

• none found

There seems to be no evidence of a difference between purse-string and linear skin closure regarding:

• incisional hernia (but the evidence is very uncertain)
• operative time (but the evidence is very uncertain)
• length of hospital stay (but the certainty of evidence is unknown)
• anastomotic leak (but the certainty of evidence is unknown)
• intestinal obstruction (but the certainty of evidence is unknown)

Which skin closure technique is best to use after stoma reversal?
Purse-string skin closure both has the theory and the evidence to back up a lower risk of surgical site infections compared with linear skin closure, seemingly without any risks of complications. The result from this Cochrane review could make surgeons reconsider their skin closure method in patients undergoing stoma reversal. A change of practice from linear to purse-string skin closure is both straightforward and inexpensive.

Clinical reflections on the implications of the review
When asking Professor Jacob Rosenberg, the co-ordinating editor of the Cochrane Colorectal Group, about the clinical implications of this Cochrane Review, he stated that:

• This review clearly shows that a simple change in skin closure technique can have a large impact on patient outcome after stoma reversal.
• The purse-string skin closure technique for the stoma site is simple, effective, and seemingly without negative effects.
• These results have the potential to change clinical practice around the world.
• The recommendation to use the purse-string method for skin closure of stoma sites should be included in future clinical guidelines.

Read the full Cochrane Review and plain language summary in the Cochrane Library 

Listen to the lead author, Shahab Hajibandeh from Health Education and Improvement Wales, to tell us more about this review in three minutes

Hajibandeh S, Hajibandeh S, Maw A. Purse‐string skin closure versus linear skin closure in people undergoing stoma reversal. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD014763. DOI: 10.1002/14651858.CD014763.pub2. 

Image: The featured image at the top of the page was created by Malene Agnete Højland and Louise Rosengaard from the Cochrane Colorectal Group.

Cochrane marks the second anniversary of the commitment to Public Involvement in Health and Social Care Research, a pledge launched in March 2022. This commitment underscores Cochrane's ongoing efforts to enhance its practice of public involvement in health and social care research.

Cochrane is one of twenty-one organizations signed up to the pledge, including the UK’s National Institute for Health and Care Research (NIHR) and the Health Research Authority (HRA).

Richard Morley, Cochrane's Consumer Engagement Officer, reflects on this initiative: “Making a public commitment to involving the users of our evidence sets out our serious intent to build on our past achievements and deepen and broaden our work.”

A notable achievement is the establishment of the Co-Production Methods Group, launched in October 2023. Aligned with the ‘Putting People First’ commitment, this group will spearhead methods research, share resources for best practice, and supports learning and dissemination activities to help systematic review authors engage with and respond to the needs of consumers. 

To help people make sense of health evidence, Cochrane provides a free Evidence Essentials learning module. This free online resource offers an introduction to health evidence and how to use it to make informed health choices. The module has been co-produced by healthcare consumers, researchers and Cochrane's specialists, with contributions from a range of experts in their fields.

The Learning Live series builds on this, offering free webinars aimed at a range of audiences. Some webinars are aimed at Cochrane review authors, to help them make their research more widely accessible and understood. Others are aimed at helping people to engage with Cochrane research, such as webinars for teachers on using Cochrane Crowd in school projects. 

Looking ahead, Cochrane has a framework for consumer engagement and involvement that runs until 2027. This comprehensive approach revolves around five key elements. It emphasizes proactive engagement strategies, including communication, evidence dissemination, recruitment, and learning. Cochrane aims to elevate co-production by intensifying consumer involvement in the evidence production process, aligning reviews with user needs, and supporting consumer governance.

Prioritizing accessibility, the framework strives to enhance health literacy among healthcare consumers while making Cochrane's evidence more easily accessible. Strategic partnerships, particularly with patient groups, aim to enhance engagement, co-production, advocacy, and health literacy activities.

Finally, the framework incorporates an observatory to ensure evidence-based practices, monitor, and evaluate the impact of Cochrane's ongoing efforts in engagement and involvement.

• Learn more about Cochrane’s commitment to healthcare consumers
• Join Cochrane’s work as a patient, carer, or member of the public
• Email the Cochrane Consumers Network at consumers@cochrane.org 

Specifications: Permanent – Full Time
Salary:  £55,000 - £57,000 per Annum  
Location: Remote - 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.
Closing date: 24 March 2024

Cochrane is an international charity. For 30 years we have responded to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesising research findings and our work has been recognised as the international gold standard for high quality, trusted information.

Cochrane's strength is in its collaborative, global community. We have 110,000+ members and supporters around the world. Though we are spread out across the globe, our shared passion for health evidence unites us. Our Central Executive Team supports this work and is divided into four directorates: Evidence Production and Methods, Publishing and Technology, Development, and Finance and Corporate Services.

The Executive Editor will be expected to prioritise and delegate editorial tasks as appropriate. The role holder will need to be an advocate for the Editorial Service internally and externally to Cochrane and remain alert to immediate demands of delivering high-quality review content for publication in a timely fashion.        

Don’t have every single qualification? We know that some people are less likely to apply for a job unless they are a perfect match. At Cochrane, we’re not looking for “perfect matches.” We’re looking to welcome people to our diverse, inclusive, and passionate workplace. So, if you’re excited about this role but don’t have every single qualification, we encourage you to apply anyway. Whether it’s this role or another one, you may be just the right candidate.

Our organization is built on four core values: Collaboration: Underpins everything we do, locally and globally. Relevant: The right evidence at the right time in the right format. Integrity: Independent and transparent. Quality: Reviewing and improving what we do, maintaining rigour and trust.  

You can expect:  

• An opportunity to truly impact health globally  
• A flexible work environment  
• A comprehensive onboarding experiences
• An environment where people feel welcome, heard, and included, regardless of their differences

Cochrane welcomes applications from a wide range of perspectives, experiences, locations and backgrounds; diversity, equity and inclusion are key to our values.

How to apply

• For further information on the role and how to apply, please click here
• The deadline to receive your application is 24th March 2024
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.  Read our Recruitment Privacy Statement

Cochrane's strength is in its collaborative, global community. Cochrane Geographic Groups represent Cochrane in their host country, advocate for the use of Cochrane evidence in health policy and practice, and support Cochrane's members and supporters who live there.  Here we look more closely at the impact of Cochrane Thailand, exploring its initiatives and contributions to advancing healthcare not only within Thailand but also across the Southeast Asian region.

Since its inception in 2002, initially as the Thai Cochrane Network before evolving into Cochrane Thailand in 2003, the group has been steadfast in its commitment to disseminating the fundamental concepts of research synthesis and championing the importance of evidence-based healthcare. Located at Khon Kaen University in Northeast Thailand, Cochrane Thailand shares information about Cochrane, translates Cochrane plain language summaries into Thai, and provides workshops about preparing Cochrane reviews and how to use the Cochrane related software. 

"We are dedicated to promoting the use of Cochrane evidence in healthcare decision-making, with a focus not only on local but also global impact," states Professor Pisake Lumbiganon, Convenor of Cochrane Thailand. "Our designation as the WHO Collaborating Centre for Research Synthesis in Reproductive Health in 2014 and as the WHO HRP Alliance Hub for research capacity strengthening for WHO/SEARO in 2017 underscores our commitment to driving change on a global scale. The reviews we contribute to have a far-reaching impact, with many being incorporated into WHO guidelines. Cochrane Thailand takes pride in its role in shaping healthcare practices both within Thailand and beyond." 

One of the group's primary objectives is to facilitate training workshops on Cochrane review preparation and the utilization of related software tools like RevMan and GRADE. These workshops have been instrumental in empowering healthcare researchers across Asia, fostering a community of those equipped with the necessary skills to conduct rigorous research synthesis.

In addition to training initiatives, Cochrane Thailand actively collaborates with various national and international organizations to generate evidence and inform healthcare policies and guidelines. Notably, the group has been invited to support WHO guideline development groups on critical health issues, contributing to the formulation of recommendations that impact healthcare practices globally. Another notable project was working with Cochrane Australia on the five-year 'South East Asia - Optimising Reproductive and Child Health in Developing Countries' project that helped to improve the clinical practice of treating pregnancy and childbirth-related disorders and enhance the health outcomes of mothers and infants in South East Asia. 

Cochrane Thailand has also been instrumental in translating Cochrane evidence into Thai, ensuring accessibility for Thai-speaking healthcare professionals, patients and families, and policymakers. With over 1,000 translated Cochrane reviews, the group has significantly enhanced the dissemination and utilization of evidence-based information in the region. "We believe that language should not be a barrier to accessing high-quality healthcare information. Our translation efforts aim to bridge this gap and empower healthcare stakeholders with valuable evidence. We are very proud and thankful to all our volunteer Thai translators who are helping make an impact," emphasizes Nampet Jampathong who helps coordinate the Thai translation.

Looking ahead, Cochrane Thailand is excited about being a Centre of Research Excellence for the project called Accelerating Research and Progress in maternal And Newborn health (ARPAN). This project will help to address the major gaps across the Asia-Pacific region to improve outcomes for women and newborns. 

Cochrane Thailand welcomes collaboration and support from individuals and organizations passionate about making a difference in healthcare. they are looking for funding opportunities to continue to expand their impact throughout South Asia.  Whether through training workshops, research collaborations, or translation efforts, Cochrane Thailand remains dedicated to its vision of enhancing healthcare practices and policies through rigorous research synthesis and evidence dissemination.

• Visit the Cochrane Thailand website
• Follow Cochrane Thailand on X
• View Cochrane Evidence in Thai
• Find a Cochrane Geographic Group in your country