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    Alison Weightman presentation WSPCR 2011 Alison Weightman presentation WSPCR 2011 Presentation Transcript

    • Systematic reviews, Cochrane+ and SURE Alison WeightmanSupport Unit for Research Evidence October 2011
    • Today’s Presentation• Why systematic reviews?• SURE: Background• Cochrane+: sources of SRs for public health & primary care• The nub! How helpful for policy and practice?• SURE: Current approaches
    • Evidence based decision making in primary care and public healthWhy look for systematic review(s) first“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” http://www2.cochrane.org/resources/glossary.htm
    • 1. Reliable• Avoids selection bias (where an author may choose studies supporting his or her view) since all relevant studies are included• Inclusion/exclusion criteria decided at the outset• Example is for intervention studies
    • 2. Transparent• The methodology is given in full and can be reproduced exactly by others
    • 3. Makes financial sense• A systematic review can be a quicker and cheaper way of finding out what works than embarking on a new primary research study.• Current surge of interest within and far beyond the health sphere [partly as a result of the financial recession?]
    • 4. Separates the wheat from the chaff• Separating well conducted and salient studies that are worthy of further consideration and reflection from poorly conducted studies – critical appraisal
    • 5. Generalisable• If studies are similar enough, results from different areas of the globe can be combined to increase generalisability.• Synthesis methods may be employed – eg meta- analysis for efficacy studies, meta-ethnography for „views & opinions‟ studies.
    • 6. Global reputation• Started within health care & in developed economies – eg Cochrane collaboration - but now far beyond health care and global.• Campbell: education, crime & justice, social welfare 3ie & DFID: Aid policy and international development
    • 7. Internationally agreed standards• For journal and other publications, editors are increasingly adopting international and stringent criteria eg• PRISMA for systematic reviews of evaluation studies; MOOSE for systematic reviews of observational studies
    • 8. Systematic reviews are used by..• Professionals to guide their practice• Economic analysts to estimate likely costs of interventions based on effectiveness• Researchers to guide future research• Policy makers to decide policy
    • SURE: Support Unit for Research Evidence Part of the Information Services Directorate Based at the Cardiff University Heath Campus Established in 2000 Almost entirely grant funded
    • SURE: Background• Specialists in, but not limited to, public health/social science• Trials Search Coordinators and the Specialized Register of Studies for the Cochrane Public Health Group• Home of Co-convenor of the Cochrane Information Retrieval Methods Group• Particular skills in:  Critical appraisal  Advanced literature searching  Summarising research evidence  Teaching systematic review methods • 50 publications including 44 systematic reviews since 2000 • >£2 million in grant income
    • Advanced literature Searching•Complex search strategies in electronic databases•Grey literature:  Conference proceedings  Trial registers  Internet searching • Google scholar • Web sites of relevant organisations•Contacting experts •Reference lists of relevant papers
    • Identification of the Indicators of the Social Determinants of Cancer, Child Health and Older People‟s Health
    • Databases and information sources• Age Line • NICE [includes ReFer, Regard,• ASSIA SIGLE, Intute]• ChildData • PsycINFO• CINAHL • Science Citation Index• Cochrane Library • Social Care Online• Community Wise • Social Science Citation Index• Embase • Social Services Abstracts• EPPI Centre • Sociological Abstracts• ERIC • Local Government Data Unit• HMIC Wales• IBSS • NHS Plans & National Service Frameworks for Wales and• IDOX Information Services England within subject areas• Medline [Includes CancerLit]
    • Search StrategySocial determinant terms1 prosperity.mp. (350) 18 house own$.mp. (13)2 wealth.mp. (3929) 19 renter.mp. (5)3 unemploy$.mp. (7367) 20 car own$.mp. (77)4 poverty.mp. (20570) 21 overcrowd$.mp. (1195)5 earning$.mp. (1908) 22 income.mp. (35798)6 low pay.mp. (49) 23 standard of living.mp. (417)7 salary.mp. (1800) 24 central heating.mp. (114)8 debt$.mp. (1905) 25 family conflict.mp. (387)9 arrear$.mp. (16) 26 poor housing.mp. (163)10 social class.mp. (23104) 27 educational attainment.mp. (1616)11 socio-economic.mp. (8590) 28 educational achievement.mp. (403)12 socioeconomic.mp. (80451) 29 deprivation.mp. (41158)13 social security.mp. (6863) 30 inequalit$.mp. (7500)14 social welfare.mp. (6070) 31 financial hardship.mp. (104)15 social mobility.mp. (595) 32 social position.mp. (359)16 housing tenure.mp. (127) 33 damp housing.mp. (38)17 home own$.mp. (152) 34 social isolation.mp. (9350)
    • Search Strategy33 damp housing.mp. (38) 56 perceived inadequacy.mp. (22)34 social isolation.mp. (9350) 57 civic communit$.mp. (5)35 social exclusion.mp. (199) 58 domestic violence.mp. (3744)36 social network$.mp. (2730) 59 engagement in community.mp. (3)37 decision latitude.mp. (236) 60 social stigma.mp. (296)38 social relationship$.mp. (1480) 61 social capital.mp. (418)39 effort-reward.mp. (113) 62 social status.mp. (2220)40 job opportunit$.mp. (174) 63 family status.mp. (271)41 promotion prospects.mp. (27) 64 single parent.mp. (1513)42 social gradient.mp. (135) 65 sole parent.mp. (9)43 family breakdown.mp. (46) 66 lone parent.mp. (35)50 social cohesion.mp. (138 67 divorce.mp. (4268)51 poor environment.mp. (93) 68 marital separation.mp. (61)52 social contacts.mp. (673) 69 ethnic$.mp. (59718)53 social attachment$.mp. (97) 70 refugee$.mp. (5355)54 social integration.mp. (965) 71 good nutrition.mp. (296)55 emotional ties.mp. (37)
    • Search Strategy72 household composition.mp. (163) 89 *"Public Housing"/ (370)73 family composition.mp. (184) 90 property own$.mp. (46)74 crowding.mp. (4126) 91 racial$.mp. (12725)75 school performance.mp. (1198) 92 sociodemographic.mp. (9350)76 school attendance.mp. (463) 93 inequit$.mp. (1698)77 housing condition$.mp. (1117) 94 disadvantaged.mp. (3422)78 benefit recipient$.mp. (11) 95 Immigrant$.mp. (7999)79 household type.mp. (37) 96 Rental.mp. (243)80 housing design.mp. (27) 97 affluen$.mp. (1820)81 employment status.mp. (1983) 98 Rented.mp. (166)82 economic inactivity.mp. (8) 99 Salaries.mp. (11250)83 social housing.mp. (91) 100 shift work.mp. (1052)84 access to health care.mp. (1878) 101 social disparit$.mp. (89)85 access to services.mp. (525) 102 social effect$.mp. (360)86 community participation.mp. (984) 103 uninsured.mp. (5085)87 social environment.mp. (26711) 104 social inclusion.mp. (76)88 Social disadvantage.mp. (237) 105 or/1-104 (351713)
    • Search StrategyStudy terms106 exp Controlled Clinical Trials/ 115 exp Meta-Analysis/ (7588) (53225) 116 meta-analys$.ti,ab. or107 exp Random Allocation/ (59871) metaanalys$.ab,ti. or meta108 exp Double-Blind Method/ (93163) analys$.ab,ti. (17210)109 exp Single-Blind Method/ (11128) 117 Cochrane.ab,sh,ti. (8158)110 ((singl$ or doubl$ or trebl$ or tripl$) 118 (review$ or overview$).ti. or adj5 (blind$ or mask)).ti,ab. (88154) review$.pt. or (synthes$ adj3111 (control$ adj (trial$ or stud$ or (literature$ or research or studies or evaluation$ or experiment$)).mp. data)).ab,ti. (1361158) (419822) 119 pooled analys$.ab,ti. or ((data adj2112 randomi?ed.hw,ti,ab,pt. (336615) pool$) and studies).mp. (3068)113 (cohort: or survey: or qualitativ: or 120 ((hand or manual or database$ or cross section: or case stud: or evaluat: computer$) adj2 search$).ab,ti. or audit: or longitudinal: or (10520) questionnaire:).ti,ab. (1757661) 121 ((electronic or bibliographic$) adj2114 (case stud: or evaluat: or audit: or (database$ or data base$)).ab,ti. longitudinal: or questionnaire:).ti,ab. (2627) (1453166)
    • Search Strategy122 ((review$ or overview$) adj10 Cancer terms (systematic$ or methodologic$ or 128 neoplasm$.mp. (1486462) quantitativ$ or research$ or 129 malignan$.mp. (273106) literature$ or studies or trial$ or 130 Polycythemia Vera.mp. (3927) effective$)).ab. (148334) 131 Myeloproliferative Disorder$.mp.123 census$.mp. (10083) (4717)124 registry.mp. (22497) 132 cancer$.mp. (611077)125 registries.mp. (30974) 133 exp neoplasms/ (1830218)126 follow up stud$.mp. (356983) 134 tumo?r$.mp. (951252)127 or/106-126 (3598245) 135 Myelodysplastic Syndrome$.mp. (9373) 136 Immunoproliferative Disorder$.mp. (133) 137 or/128-136 (2145924) 138 105 and 127 and 137 (13438) Social Cancer determinant Study design terms terms terms
    • Additional Search Methods• Hand searching reference lists• Contacting experts• Electronic Tables of Content (ETOCs)• Website search
    • Critical AppraisalThe in-depth examination of theresearch evidence to assess its validity,results and relevance before using it toinform a decision “The science of „trashing‟ papers” (Greenhalgh T. 1997 BMJ publications)
    • CriticalAppraisal
    • Summarising the EvidenceTo make an accurate summary of all theappraised evidence, including methodologyand quality
    • CompletedProjects: Examples
    • Top five sources of systematic reviews of relevance to public health in the UK1. Cochrane Library www.thecochranelibrary.com/2. Database of promoting health effectiveness reviews (DoPHER), EPPI-Centre http://eppi.ioe.ac.uk/webdatabases/Intro.aspx?ID=23. Health Evidence Canada http://health- evidence.ca/articles/search4. PubMed clinical queries http://www.ncbi.nlm.nih.gov/pubmed/clinical5. NICE www.nice.org.uk/
    • 1. Cochrane Library
    • 2. DoPHER
    • 3. Health Evidence ca
    • 4. PubMed Clinical Queries
    • 5. NICE guidelines
    • Value of SRs for policy?• Participants • Timely - frequent updates/current• Intervention • Orientated to policy•• Comparison Outcomes ≠ • Problem driven – meaningful outcomes• Setting • Implementation - costed • Context – what works for whom?
    • Current Projects:Examples
    • Collaboration review update
    • NICE THR guidance: Linking efficacy and barriers/facilitators evidenceFigure: From Harden A, Brunton G, Fletcher A, Oakley A. Teenage pregnancy and social disadvantage:systematic review integrating controlled trials and qualitative studies. BMJ 2009; 339: b4254
    • SURE• Informal advice on finding evidence to support primary care and public health• Training• Information support for grant applications• Research partnerships/shared bids• Commissions
    • Training workshops
    • To encourage and assistcollaborative working between researchers involved in systematic reviewshttp://www.cf.ac.uk/insrv/libraries/sure/sysnet/index.html
    • Finally…Information is a source of learning. But unless it is organised, processed, and available to the right people in a format for decision making, it is a burden, not a benefit.”William PollardThe Soul of the Firm. Grand Rapids: Zondervan Publishing House 2000
    • SURE@cf.ac.uk WeightmanAL@cf.ac.ukwww.cardiff.ac.uk/insrv/sure