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Challenges in Systematic Reviews—Can Using Existing Reviews Save   Time? Be Valid?   Evelyn P. Whitlock, MD, MPH Associate Director, Oregon Evidence-based Practice Center Senior Investigator, Center for Health Research, KPNW Jennifer Lin, MD, MCR Center for Health Research, KPNW Roger Chou, MD Oregon Health & Science University July 11, 2008
Acknowledgments ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],Background
Estimated growth in annual MEDLINE-indexed English language Systematic Reviews   *Moher D, et al. PLoS Med 2007
Growth in SRs within USPSTF topics 205 2007 Screening for cervical cancer  428 2006 Screening for adult depression 24 2005 Motor vehicle occupant injury (MVOI) prevention interventions 15 2004 Pediatric obesity screening and interventions Abstracts Year Topic
Reviewers’ Questions about Using Existing Systematic Reviews ,[object Object],[object Object],[object Object],[object Object]
Possible benefits in utilizing existing systematic reviews ,[object Object],[object Object],[object Object]
Types of Reviews and Available Methodological Guidance Current Guidance NHS; Cochrane Guidance underway Cochrane Manual None found Review of reviews, overview of reviews, umbrella review (e.g., NHS HDA reviews) Secondary research (i.e., systematic reviews, meta-analyses) (Complex) systematic review, evidence report  (e.g., EPC report) Both primary and secondary research To inform policy-level medical decision making (e.g., clinical guidelines, health care coverage decisions) Complex review, multiple interventions or linked questions Systematic review,  (e.g., Cochrane review) Primary research (i.e., individual studies) To answer a focused question (gain statistical power and applicability over individual studies) Single question, focused review Nomenclature (example) Admissible evidence Purpose Type
 
Methodological steps when using existing systematic reviews (SRs)
Does it save time/resources?
Growth in SRs within USPSTF topics *Not including use for reference checking 2 29 205 2007 Cervical Cancer screening 10 112 428 2006 Adult Depression screening 0 24 24 2005 MVOI prevention interventions 1 15 15 2004 Pediatric obesity screening and interventions Included* Articles Abstracts Year Topic
Does it save time/resources? ,[object Object],[object Object]
When may a new review be needed? ,[object Object],[object Object],[object Object],[object Object]
Other possible hazards in using existing SR ,[object Object],[object Object],[object Object],[object Object],[object Object]
Implications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Steps forward… ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
OHSU EPC –   http://www.ohsu.edu/epc KPCHR   –   http://www.kpchr.org/public/default.aspx AHRQ’s   Effective Health Care Program –   http://effectivehealthcare.ahrq.gov/ USPSTF   –   http://www.ahrq.gov/clinic/uspstfix.htm Websites
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Incorporating systematic reviews into other systematic reviews: Can we save time and be valid?

  • 1. Challenges in Systematic Reviews—Can Using Existing Reviews Save   Time? Be Valid? Evelyn P. Whitlock, MD, MPH Associate Director, Oregon Evidence-based Practice Center Senior Investigator, Center for Health Research, KPNW Jennifer Lin, MD, MCR Center for Health Research, KPNW Roger Chou, MD Oregon Health & Science University July 11, 2008
  • 2.
  • 3.
  • 4. Estimated growth in annual MEDLINE-indexed English language Systematic Reviews *Moher D, et al. PLoS Med 2007
  • 5. Growth in SRs within USPSTF topics 205 2007 Screening for cervical cancer 428 2006 Screening for adult depression 24 2005 Motor vehicle occupant injury (MVOI) prevention interventions 15 2004 Pediatric obesity screening and interventions Abstracts Year Topic
  • 6.
  • 7.
  • 8. Types of Reviews and Available Methodological Guidance Current Guidance NHS; Cochrane Guidance underway Cochrane Manual None found Review of reviews, overview of reviews, umbrella review (e.g., NHS HDA reviews) Secondary research (i.e., systematic reviews, meta-analyses) (Complex) systematic review, evidence report (e.g., EPC report) Both primary and secondary research To inform policy-level medical decision making (e.g., clinical guidelines, health care coverage decisions) Complex review, multiple interventions or linked questions Systematic review, (e.g., Cochrane review) Primary research (i.e., individual studies) To answer a focused question (gain statistical power and applicability over individual studies) Single question, focused review Nomenclature (example) Admissible evidence Purpose Type
  • 9.  
  • 10. Methodological steps when using existing systematic reviews (SRs)
  • 11. Does it save time/resources?
  • 12. Growth in SRs within USPSTF topics *Not including use for reference checking 2 29 205 2007 Cervical Cancer screening 10 112 428 2006 Adult Depression screening 0 24 24 2005 MVOI prevention interventions 1 15 15 2004 Pediatric obesity screening and interventions Included* Articles Abstracts Year Topic
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.  
  • 19. OHSU EPC – http://www.ohsu.edu/epc KPCHR – http://www.kpchr.org/public/default.aspx AHRQ’s Effective Health Care Program – http://effectivehealthcare.ahrq.gov/ USPSTF – http://www.ahrq.gov/clinic/uspstfix.htm Websites

Editor's Notes

  1. As a reminder, the conference is about setting priorities in systematic reviews, so I would steer you towards this perspective in your talks.  In the new talk on using systematic reviews, I would think the discussion would center around the resource savings accomplished by using existing reviews (and thus the ability to do more reviews or update more existing reviews) vs the potential for quality loss. You cover these items in you paper, I just wanted to make sure we focus the talks in the same direction as the conference as a whole.