C A N C A C Training Day R A D E R 12 J A N08


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  • Hi Tamara - this is neat and I'd like to try using this format if we decide to do the Intro to Cochrane session before the symposium. Could use phone and each person access the slide show; I guess it could also be a self-learning tool.

    do you see this as a comment on slide 1?

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  • C A N C A C Training Day R A D E R 12 J A N08

    1. 1. Cochrane Consumer Activities and Access to Medical Libraries Tamara Rader Cochrane Musculoskeletal Group January 12, 2008
    2. 2. What are we going to talk about today? <ul><li>Evidence-based health care </li></ul><ul><li>Systematic reviews </li></ul><ul><li>Cochrane Collaboration </li></ul><ul><li>Access to information for all (NNLH) </li></ul><ul><li>How consumers fit in </li></ul>
    3. 3. Evidence-Based Health Care Evidence/Information Expertise or experience Values, preferences, needs
    4. 4. What is “evidence”? <ul><li>Cohort studies </li></ul><ul><li>Case control studies </li></ul><ul><li>Cross sectional surveys </li></ul><ul><li>Case reports </li></ul><ul><li>Clinical trials </li></ul><ul><li>Randomized controlled trials </li></ul><ul><li>Reviews </li></ul><ul><li>Systematic reviews </li></ul>
    5. 5. Why don’t doctors use research results in practice? <ul><li>Lack of information management </li></ul><ul><li>Individual studies may be misleading </li></ul><ul><li>Need to put results into context </li></ul>
    6. 6. Problem of information management <ul><li>Over 20,000 medical journals published per year </li></ul><ul><li>Published research of variable quality and relevance </li></ul><ul><li>Health care professionals often poorly trained in critical appraisal skills </li></ul><ul><li>Average time professionals have available to read = <1 hour/week </li></ul>
    7. 7. Need to put results into context <ul><li>The results of individual studies need to be interpreted alongside the totality of evidence (systematic reviews) </li></ul><ul><li>Emphasis on individual studies may distract us </li></ul>
    8. 8. Individual studies may be misleading <ul><li>Analyzed 115 articles published in 1990-2003 in the 3 major general medical journals (NEJM, JAMA, Lancet) and specialty journals that had received over 1000 citations each by August 2004 </li></ul><ul><li>49 reported evaluations of health care interventions; 45 claimed that the interventions were effective. </li></ul><ul><li>By 2004 5/6 non randomised studies and 9/39 randomised trials were already contradicted or found to be exaggerated </li></ul><ul><ul><li>Ioannidis JP. JAMA 2005 </li></ul></ul>
    9. 9. What do we need to manage the flow of information, keep it in context, and not be mislead by individual studies? <ul><li>Reviews ! </li></ul>
    10. 10. Reviews <ul><li>Are a collection of material on a given subject </li></ul><ul><li>Looks at all studies on a specific topic (treatment, correct way to diagnose, prevention) </li></ul><ul><li>Two ways to review literature: Narrative or Systematic </li></ul>
    11. 11. Narrative Reviews of the Literature <ul><li>Concerns: </li></ul><ul><ul><li>Not focused </li></ul></ul><ul><ul><li>Studies excluded or missed </li></ul></ul><ul><ul><li>Inappropriate assessment of studies </li></ul></ul><ul><ul><li>Inappropriate comparison of studies </li></ul></ul><ul><ul><li>Author bias </li></ul></ul>
    12. 12. What is a systematic review? <ul><li>Systematic reviews are a way of synthesizing research evidence from many studies </li></ul><ul><li>Systematic reviews are a basic building block for planning future research </li></ul>
    13. 13. NARRATIVE VS SYSTEMATIC <ul><li>equal weight of studies High quality studies and weighted </li></ul><ul><li>General overview Focused question </li></ul>?Search strategy Methodical and reproducible search ?assessment of studies Quality & relevance assessed ?bias Impartial and relevant results
    14. 14. What can systematic reviews tell us? <ul><li>Systematic reviews (including meta-analysis) generic method for addressing different questions – </li></ul><ul><ul><li>Epidemiological reviews of observational data </li></ul></ul><ul><ul><li>Reviews of diagnostic test performance </li></ul></ul><ul><ul><li>Reviews of effectiveness of interventions </li></ul></ul><ul><ul><li>Reviews of efficiency of interventions </li></ul></ul><ul><ul><li>Reviews of qualitative research </li></ul></ul><ul><ul><li>Reviews of research methods </li></ul></ul><ul><ul><li>Reviews of theories and models </li></ul></ul>
    15. 15. Meta-analysis <ul><li>The use of statistical techniques in a systematic review to integrate the results of included studies. </li></ul><ul><li>Cochrane Collaboration (2005) Glossary of Terms in The Cochrane Collaboration </li></ul>
    16. 18. What is the Cochrane Collaboration? <ul><li>Cochrane Collaboration is a unique worldwide organization producing and disseminating systematic reviews on the effects of health care interventions </li></ul>
    17. 19. <ul><li>The Cochrane Collaboration is an international organisation that aims to help people make well­informed decisions about health care by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions. It is a not­for­profit organisation, established as a company, limited by guarantee, and registered as a charity in the UK . </li></ul>Mission Statement
    18. 20. Cochrane Collaboration’s vision: <ul><li>Healthcare decision-making throughout the world will be informed by high quality, timely research evidence. </li></ul><ul><li>The Cochrane Collaboration will play a pivotal role in the production and dissemination of this evidence across all areas of health care. </li></ul>
    19. 21. Organization of Cochrane International Steering Group - Governs the Cochrane Collaboration -Comprised of a group of elected representatives from the 5 types of Cochrane Groups (entities) Fields/Networks 13 Collaborative Review Groups (CRG) 50 Methods Groups (MG) 10 Centres 12
    20. 22. Writing Reviews Commenting on Reviews Editing Reviews Disseminating Reviews Searching for good studies Management
    21. 23. Who Does What? <ul><li>Collaborative Review Groups (CRG) </li></ul><ul><li>- develop and maintain systematic reviews relevant to a particular health area </li></ul><ul><li>- groups are coordinated by an editorial team who edit and assemble completed reviews into modules for inclusion in The Cochrane Library </li></ul><ul><li>examples: Musculoskeletal, Effective Practice & Organization of Care, Back, Breast Cancer, Infectious Diseases, Tobacco Addiction Group </li></ul>
    22. 25. 6 review groups based in Canada <ul><li>Back Review Group- Toronto </li></ul><ul><li>Effective Practice and Organisation of Care Review </li></ul><ul><li>Group - Ottawa </li></ul><ul><li>Hypertension Review Group - Vancouver </li></ul><ul><li>Inflammatory Bowel Disease Review Group - London </li></ul><ul><li>Musculoskeletal Review Group - Ottawa </li></ul><ul><li>Neonatal Review Group - Hamilton </li></ul>
    23. 26. Who Does What? <ul><li>Consumer Network </li></ul><ul><li>- International network that facilitates the dissemination of information to patients, their families, friends and advocates </li></ul><ul><li>Ensures consumer needs and interests are incorporated into the operation of the Collaboration </li></ul><ul><li>Provides input to all activities of the Collaboration </li></ul><ul><li>Helps set priorities for review topics </li></ul><ul><li>Helps with translation of reviews </li></ul>
    24. 27. Affiliate Organizations <ul><li>Representatives from 20 healthcare professional organizations and consumer groups </li></ul><ul><li>Purposes: </li></ul><ul><ul><li>Advise on future directions and activities </li></ul></ul><ul><ul><li>Promote the awareness, appreciation, distribution and use of Cochrane systematic reviews among their members </li></ul></ul>
    25. 28. Affiliate Organizations <ul><li>L’Agence de é valuation des technologies et des modes d’intervention en sant é </li></ul><ul><li>Arthritis Society </li></ul><ul><li>Canadian Association of Occupational Therapists </li></ul><ul><li>Canadian Association of Speech-Language, Pathologists and Audiologists </li></ul><ul><li>Canadian Cancer Society </li></ul><ul><li>Canadian Chiropractic Association </li></ul><ul><li>Canadian Coordinating Office for Health Technology Assessment </li></ul><ul><li>Canadian Dental Association </li></ul><ul><li>Canadian Health Libraries Association </li></ul><ul><li>Canadian Institute for Health Information </li></ul><ul><li>Canadian Institute for the Relief of Pain and Disability </li></ul>
    26. 29. Affiliate Organizations <ul><li>Canadian Medical Association </li></ul><ul><li>Canadian Nurses Association </li></ul><ul><li>Canadian Pharmacists Association </li></ul><ul><li>Canadian Physiotherapy Association </li></ul><ul><li>Canadian Task Force on Preventive Health Care </li></ul><ul><li>Canadian Women’s Health Network </li></ul><ul><li>College of Family Physicians of Canada </li></ul><ul><li>Dietitians of Canada </li></ul><ul><li>Institute for Clinical Evaluative Sciences </li></ul><ul><li>Royal College of Physicians and Surgeons of Canada </li></ul>
    27. 30. People in Cochrane <ul><li>Over 10,000 involved internationally </li></ul><ul><li>About 80 countries </li></ul><ul><li>Mostly volunteers </li></ul><ul><li>Diverse backgrounds, experience and expertise </li></ul>
    28. 31. People in Cochrane <ul><li>Epidemiologists/Statisticians </li></ul><ul><li>Healthcare professionals </li></ul><ul><li>Consumers </li></ul><ul><li>Librarians </li></ul>
    29. 32. What is found in a Cochrane Review? <ul><li>Consumer summary (Synopses, Plain Language Summary) </li></ul><ul><li>Abstract </li></ul><ul><li>Background </li></ul><ul><li>Objectives </li></ul><ul><li>Selection Criteria for studies </li></ul><ul><li>Search strategy </li></ul><ul><li>Methods of the review </li></ul><ul><li>Description of studies </li></ul><ul><li>Methodological qualities of included studies </li></ul><ul><li>Results </li></ul><ul><li>Summary of analyses </li></ul><ul><li>Conclusions </li></ul><ul><li>Potential conflict of interest </li></ul><ul><li>Acknowledgements </li></ul>
    30. 33. Steps in Production <ul><li>Identify and prioritise topics </li></ul><ul><li>to synthesise </li></ul>TITLE PROTOCOL REVIEW <ul><li>Plan how to synthesise the studies </li></ul><ul><li>Identify why important to do this synthesis </li></ul><ul><li>Identify special groups to look at, benefits & harms to report, factors that might change the results </li></ul><ul><li>Write the protocol </li></ul><ul><li>Send protocol for comment </li></ul><ul><li>Edit protocol </li></ul><ul><li>Find, analyse and synthesise the studies </li></ul><ul><li>Interpret results and determine impact of findings </li></ul><ul><li>Write review </li></ul><ul><li>Send review for comment </li></ul><ul><li>Edit review </li></ul><ul><li>Publish Cochrane review </li></ul>
    31. 34. Preparing a Title TITLE <ul><li>evidence of value in identifying primary research topics </li></ul><ul><li>show the difference in what is done and what would like to see done </li></ul><ul><li>Challenges </li></ul><ul><li>not an emphasis </li></ul><ul><li>reviewer driven </li></ul><ul><li>individual bias or public consensus not known </li></ul>
    32. 35. Preparing a Protocol PROTOCOL <ul><li>Value in recognizing all factors in studies that are relevant and important to people making health care decisions </li></ul><ul><li>Background, Participants, Interventions, Outcomes </li></ul><ul><li>Examples: </li></ul><ul><li>peer review of protocols </li></ul><ul><li>working with reviewers </li></ul>
    33. 36. Preparing the review REVIEW <ul><li>value of consumers to determine meaning of the results to other consumers and put results in context </li></ul><ul><li>Challenges </li></ul><ul><li>knowledge of methods, analysis, limitations </li></ul><ul><li>time commitment (mutual) and recruitment </li></ul><ul><li>feedback and recognition </li></ul><ul><li>timelines </li></ul>
    34. 37. The Cochrane Library The main output of The Cochrane Collaboration, Cochrane Reviews, is contained in The Cochrane Database of Systematic Reviews , published electronically by John Wiley and Sons as part of The Cochrane Library .
    35. 38. The Cochrane Library <ul><li>All of the Cochrane systematic reviews are on the Internet </li></ul><ul><li>In some countries such as the UK and Australia you can access it for free, </li></ul><ul><li>Other countries you need to pay for a password to view them </li></ul><ul><li>Most universities and some hospitals have the Library for their staff </li></ul>
    36. 40. Where is the “evidence”? <ul><li>Health Journals </li></ul><ul><li>Databases </li></ul><ul><li>Web sites </li></ul><ul><li>Libraries </li></ul><ul><li>Government departments </li></ul><ul><li>Professional associations </li></ul><ul><li>Private companies </li></ul>
    37. 41. What’s wrong with that? <ul><li>Access to evidence is inequitable. </li></ul><ul><li>Not all evidence is free </li></ul><ul><li>Not all evidence is accessible to those who need it </li></ul><ul><li>Not all evidence is easy to find </li></ul><ul><li>Not easy to tell if evidence is valid </li></ul>
    38. 43. National Network of Libraries for Health <ul><li>NNLH </li></ul><ul><li>A network of existing health libraries and information services </li></ul><ul><li>Will provide equal access to the best information for patient care </li></ul><ul><li>Including databases, journals, books, reports, and web resources. </li></ul>
    39. 44. Why the need for NNLH? <ul><li>Focus groups in 2001-2002 revealed gaps in access to information for health professionals. </li></ul><ul><li>growing demand by health professionals for health information; </li></ul><ul><li>the myth that either someone is taking care of making the literature accessible, or that &quot;it's all on the web&quot;. </li></ul>
    40. 45. <ul><li>High quality health care requires evidence-based decisions </li></ul><ul><li>In the absence of a national network with equitable and coordinated access to information for health professionals…… </li></ul>Why a National Network?
    41. 46. <ul><ul><li>Many health care providers have little or no access to information resources and services </li></ul></ul><ul><ul><li>Others have access from a variety of providers – in some cases with significant duplication </li></ul></ul><ul><ul><li>Lack of access impacts significantly on health care practices and costs </li></ul></ul><ul><ul><li>Simply providing access to resources without support does not adequately meet needs of front line care providers </li></ul></ul>
    42. 47. How can NNLH help consumers? <ul><li>To inform their preferences and decisions </li></ul><ul><li>To filter out unreliable information </li></ul><ul><li>To make access to information more fair and equitable to all Canadian consumers </li></ul>
    43. 48. Where do consumers get information? <ul><li>Currently; </li></ul><ul><li>TV and print media </li></ul><ul><li>Individual doctor or health care professional </li></ul><ul><li>Friends and family </li></ul><ul><li>Public library or hospital library </li></ul><ul><li>Internet websites of unknown quality </li></ul>
    44. 49. What’s wrong with that? <ul><li>Contradictory or inaccurate research results reported in the media </li></ul><ul><li>Doctors, friends and family may or may not have current information </li></ul><ul><li>Individual libraries have limited collections </li></ul><ul><li>Web sites are of variable quality </li></ul>
    45. 50. Canadian Health Network <ul><li>Providing health and lifestyle information in French and English since 1999. </li></ul><ul><li>Collaboration of 26 major health organizations, universities, hospitals, and libraries. </li></ul><ul><li>Was mandated with providing access to information to Canadian consumers. </li></ul>
    46. 51. What’s the solution? <ul><li>Journalists being clear on the quality of the evidence </li></ul><ul><li>Emphasizing results of systematic reviews over individual studies </li></ul><ul><li>Access to high quality information to doctors and patients and family members alike </li></ul><ul><li>Creating a network of libraries so consumers can benefit from the collection of all the libraries in the network </li></ul>
    47. 52. NNLH Vision <ul><li>The National Network of Libraries for Health (NNLH) will ensure that all health care providers in Canada will have equal access to the best information for patient care. It is designed to fit the Canadian health care model and fill in the information gaps inherent in a complex health delivery system. </li></ul>
    48. 53. Activities 2006-2007 <ul><li>Spring 2006 – CoO RFP </li></ul><ul><li>Summer 2006 – CoO completed </li></ul><ul><li>Thank-you: CISTI, PHAC, CAN, CMA </li></ul><ul><li>February 2007 – NNLH Task Force meeting </li></ul><ul><li>May 2007 – CMAJ letter </li></ul><ul><li>June 2007 – development of VHL Phase 0 with Canada Health Infoways </li></ul><ul><li>Fall 2007 – Canadian Health Network funding cancelled </li></ul>
    49. 54. Benefits of this model <ul><li>Coordinates and leverages the existing base of resources, services and expertise </li></ul><ul><li>Builds on available infrastructure and develops opportunities for local and regional libraries to improve and expand unique services </li></ul>
    50. 55. <ul><li>Provides a virtual platform to facilitate knowledge transfer and exchange at a national level </li></ul><ul><li>Preserves and provides access to key Canadian health care resources </li></ul><ul><li>Effectively identifies and addresses service and resource gaps </li></ul>
    51. 56. Services <ul><li>Virtual Help Desk </li></ul><ul><li>Training & Education </li></ul><ul><li>Broader linkages (e.g. e-health records, patient safety, later linkages, emergency response, surveillance data, consumer health info, biotech sources, CHI) </li></ul>
    52. 57. Consumer Involvement <ul><li>Participating in research studies </li></ul><ul><li>Advising on research priorities through Cochrane or other associations </li></ul><ul><li>Commenting on Cochrane protocols and reviews </li></ul><ul><li>Supporting the work of the National Network of Libraries of Health. </li></ul>
    53. 58. Thank you! Tamara Rader 613-562-5800 Ext. 2397 [email_address]