Systematic reviews and trials (Claire Allen, Evidence Aid)
Evidence Aid Systematic reviews and trials: The what and the how and the why in challenging circumstancesBonnix Kayabu (Co-ordinator) and Claire Allen (Knowledge Manager)
Outline of presentation• Background to Evidence Aid.• The Evidence Aid team.• The what, the why and the how of systematic reviews.• Reflections about systematic reviews from those preparing for and responding to natural disasters, humanitarian crises and major healthcare emergencies.• Conclusion.
Evidence Aid – why?• Established after Indian Ocean tsunami - December 2004.• Uses knowledge from systematic reviews (SRs) to provide reliable, up-to-date evidence for disasters, humanitarian crises and other major healthcare emergencies.• Provides urgent response, by bundling together brief summaries of the findings of SRs.• Improves access to SRs on the effects of interventions and actions of relevance, so as to improve health- related outcomes in major healthcare emergencies.
Who are we? Claire Allen Mike Clarke Bonnix KayabuKnowledge Manager Project Lead Co-ordinator Oxford, UK Dublin, Ireland Dublin, Ireland Belfast, UK We make up the equivalent of 1.5 full-time staff
QuestionsDo decision makers need this evidence?Do decision makers want this evidence?What are their priorities?Do relevant studies exist?Do relevant systematic reviews exist?How should we deliver this knowledge?Can we get the job done?
What is a systematic review?• A review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyse and summarise the results of the included studies.(from: http://www.cochrane.org/glossary/5#letters)
Why is a Systematic Review different?• Explicitly different from traditional literature reviews or expert commentaries in that they are transparent, rigorous and replicable.
Have trials been done in challenging circumstances?Few trials have been done in disaster settings. However, somehave been carried out, e.g.:• Onder et al randomized 103 adults to one of three different drugs to treatpost traumatic stress disorder (PTSD) after the 1999 Turkish earthquake.• Catani et al randomized 31 children with a preliminary diagnosis of PTSD ina refugee camp in north-eastern Sri Lanka to six sessions of Narrative ExposureTherapy for children, called KIDNET, or six sessions of meditation-relaxationafter the Indian Ocean tsunami.• Habib et al in Pakistan in 2006 allocated 200 children affected by anearthquake to take zinc in suspension form or as tablets as a treatment fordiarrhoea.We need to bring together the trials in a systematic way topresent the overall results of all the trials.
Systematic review process• A relevant research question developed in consultation with users.• A search strategy to find all the available studies, including journals, grey literature and unpublished studies.• A set of inclusion and exclusion criteria to select the studies for review.• A quality appraisal strategy.• Methods for synthesising the studies.
Why are systematic reviews important?• To help understand risks, benefits and consequences of decision making.• To establish whether an intervention works, does not work, or has the potential to cause harm.• To present a clearer and more consistent picture of the body of evidence.• To avoid decision-making on the basis of a single study.• To ensure decisions are based on information that is transparent, rigorous and replicable.
Reflections about systematic reviews• 83% of respondents said SRs are useful in disasters.• “Evidence from SRs could have a positive role in humanitarian interventions “ 69% “strongly agreed” and 29% “agreed”.• “SRs are not practical in decision-making about humanitarian interventions” 50% “disagreed”, 20% “strongly disagreed”.
Reflections about systematic reviews• Humanitarian interventions should be based on reliable knowledge of which interventions work, which don’t work and which are potentially harmful (‘agreed’ 25%; ‘strongly agreed’ 71%).• SRs could be used to assess the likely effects of interventions before providing funding (83% of those who have worked with donor agencies agreed).• Improved access to SRs would improve responses to natural disasters (82%).
Conclusion• Opinions on the potential role of SRs were positive.• Trials and SRs can be done in challenging circumstances, but more needs to be done to help.• Humanitarian aid workers and donors need SRs to improve their interventions and assess impact of their efforts.• They have many uncertainties for which they need research evidence.• Evidence Aid is engaging with aid workers to prioritise their needs on systematic reviews.
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