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  • Does this work for you? Mention slides
  • Who are you? Needs Experience with Cochrane and or SRs This will be posted on the ccnc website and clug website.
  • Over 20,000 health journals published per year Variable relevance To keep current, GPs must read 19 new scientific articles per day (19 x 1 hr critical appraisal…19 hours per day!) (Davidoff et al BMJ 1995) Average time professionals have available to read = <1 hour/week Pure volume of individual studies Want a summary bottom-line. One alternative is the generation of evidence-based summaries, which are in turn based on the evidence generated from systematic reviews.
  • Influence informed decision-making *Ensure relevance to end users Some people think that EB medicine is just this (circled part), but it is all of this – the balance of information, expertise and values.
  • This was Archie Cochrane, an epidemiologist who was the originator of The Collaboration. This idea was based on his belief that there was a need for the medical community to gather together the best available evidence to ensure that best clinical practice was being used.
  • International, not for profit
  • So we’ve covered many of the studies that we had in our heirarchy the other choices were the narrative reviews and systematic reviews. Reviews are another source that have become more and more useful to the health care community. Basically a review is just that – an overview of the studies that have been done about a topic or question. The value of the review is that there are so many studies now published that it is hard to read all the papers and studies out there in a particular field – so this makes it more efficient for the health care community to keep up to date on the latest research. It has been estimated that a physician would need to read 17 articles a day to keep abreast of all the new resaerch in a particular area! There is also often many studies that have confusing or contradictory results and so the review can put all the studies together and come up with a final ‘what is known’ statement. So reviews can be quite useful to consumers and physicians who are generally to busy or don’t have the resources to find all the studies about a topic, read them and combine the results, etc. Unfortunately not all reviews are created equal and there has been some concerns about reviews in general. Any ideas about why some reviews may not be so well done. Some reviews cover so much information about a topic that it is not clear what the review is actually about and what conclusions can be drawn. Some reviews haven’t found all the studies about a topic and only included for examples studies that have been published in scholarly journals – some studies may not have been published but contain very valuable information. Other reviews may have found studies and are comparing studies that use oranges and other studies that use apples or comparing studies that were done very well or not done very well or rct’s to case control studies and giving them equal weight. And still other reviews may only include studies that the author feels supports his personal viewpoint and exclude studies that refute his personal beliefs. And this leads to why the Cochrane Collaboration created the systematic review and process.
  • Generic, rigorous method to answer questions Provides the ‘big picture’ synthesis of existing research
  • Dealing with rationale for the review it self…
  • Paper based scientific journals tend to limit the number of tables and figures which emphasises the need for clear and concise writing. The Cochrane Database of Systematic Reviews allows all of the components of the systematic review to be presented in a structured way which ensures the highest quality possible.
  • Compared to systematic reviews published in Medical Journals, Cochrane reviews have… Inclusiveness of perspectives…Cochrane reviews are careful not to impose their own values, preferences, and local context Multistage process All Cochrane reviews follow the same format No word limit Many journals contain word limits which forces the authors to condense very complex information Search strategies used to identify studies include non-English language and unpublished studies Provided with plain-language summaries for non-experts Multinational editorial teams Involved right from the start of the project try to ensure review applies to different parts of the World Updated every two years Keep audience in mind while writing: abstract, plain language summary There’s no reason why some of these principles can’t be applied to the syntheses that you do, if you aren’t already.
  • Cochrane is not the only organization to produce SRs. But just a few words to highlight how Cochrane reviews are unique from other systematic reviews and why we are seen as the ‘gold standard’: Broad scope of literature included – grey lit, hand searching, registries of trials Critical appraisal – each study in the review is quality assessed using validated tools Plain language summary Updated and maintained every ~2-3 years
  • Learn a lot about the literature…
  • Use of the 'Cochrane Inside' logo A form of endorsement suitable for material containing or derived from Cochrane Collaboration outputs is the 'Cochrane Inside' logo. People or organisations wishing to use this logo should follow the same procedure as outlined in this document, with the additional criterion as to whether the item to be endorsed with the 'Cochrane Inside' logo contains or substantially derives from Cochrane Collaboration output'. Where this criterion is not met, use of the ‘Cochrane Inside’ logo will be denied. Unlike the ‘Cochrane’ logo, the ‘Cochrane Inside’ logo will not be available for use from the Cochrane website, but should be requested from the Secretariat ( [email_address] ).
  • Just like any library, the Cochrane Library is a collection of resources. It is the main output of the Cochrane Collaboration and aims to bring together in one place reliable information about the effects of health care treatments or interventions. In the Cochrane Library health care is broadly defined, so in addition to many hundreds of medical conditions, you’ll find information on such diverse topics as injury prevention for pedestrians and cyclists, St John’s wort for depression, programs to reduce juvenile delinquency, the prevention of jet lag, advice on low-fat diets for obesity, and prayer for the alleviation of ill health.
  • As of Issue 2, 2007, this database also includes the methodology reviews that were previously part of the Cochrane Database of Methodology Reviews (CDMR; Methods Reviews). As of Issue 4 2008, this database includes systematic reviews of diagnostic test accuracy.
  • THIS IS COMPARED WITH SEARCHING THE CDSR ON PUBMED
  • CENTRAL includes details of published articles taken from bibliographic databases (notably MEDLINE and EMBASE), and other published and unpublished sources. CENTRAL records include the title of the article, information on where it was published (bibliographic details) and, in many cases, a summary of the article. They do not contain the full text of the article. About three-fifths of the records in CENTRAL are taken from MEDLINE. In addition, each Cochrane Review Group maintains and updates a collection of controlled trials relevant to its own area of interest, these are called ‘Specialized Registers’. Each group may also collect items which are not relevant to its own field of interest; these are known as ‘Handsearch Results’. The registers and handsearch results are assembled and collated by Wiley before incorporation into The Cochrane Library . All Review Groups’ specialised registers, the handsearch results register, relevant records retrieved from MEDLINE, and relevant records retrieved from EMBASE, are merged as described here . EMBASE records can be identified by a sole EMBASE ID in the Accession Number field.
  • Cochrane Central Register of Controlled Trials (Clinical Trials). Includes details of published articles taken from bibliographic databases and other published resources. CENTRAL records include the title of the article, information on where it was published and, in many cases, the abstract
  • For parallel group trials, the features of interest in a standard ‘Risk of bias’ table of a Cochrane review are sequence generation, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting and other potential sources of bias.
  • Advanced Search is more flexible…
  • You can use NOT but it will automatically translate the languge to “AND NOT” in The Cochrane Library Osteoarthritis of the hip OR Osteoarthritis or the ,knee
  • Advanced Search is more flexible…
  • An even more effective way to search in order to obtain a more precise set of records, rather than having to wade through huge amounts of irrelevant records in order to find the ones of interest, is to develop a search strategy using the PICO model.
  • Evidence-based searching begins with PICO: before you start to search, think about what you’re really asking and what you’re really looking for This is the step where you start to formulate your question To compare the effectiveness and safety of aquatic-exercise interventions in the treatment of knee and hip osteoarthritis. Examples: Patients with knee or hip osteoarthritis Aquatic exercise interventions ? May be several??? Is it safe and effective No time period indicated
  • To compare the effectiveness and safety of aquatic-exercise interventions in the treatment of knee and hip osteoarthritis.
  • During this talk about Boolean AND, OR, NOT
  • Codes for each individual language
  • Need to identify what your question is… Acknowledge there are different types of questions out there…
  • For example: What is the best treatment for head lice? Does “kangaroo mother care” benefit premature babies?
  • Not for ‘on going’ research.
  • Virtual training resources and training tips training tips for different sources within the NeLH Cochrane Library: training materials, speakers’ notes and teaching tips
  • Excellent for searching details. Demonstrates almost all of the main features.
  • Small groups IF TIME
  • References also have been put on individual slides.
  • Strict conflict of interest guidelines
  • Depends on what you want
  • Select participants high-risk for outcome (high incidence) Likely to benefit and not be harmed Likely to adhere Measure baseline variables Randomize Eliminates baseline confounding Types (simple, stratified, block)
  • A second diagram from a production point of view.
  • Steering Group All Collaborative Review Groups, Methods Groups, Fields, the Consumer Network, and Centres are eligible to vote in the election of members to the Steering Group decisions are guided by goals and objectives set out in the Collaboration's Strategic Plan (http://www.cochrane.org/admin/stratplan.htm). The CCSG is elected to develop policies and strategies for the Collaboration. It has several sub-groups responsible for specific tasks. The Steering Group is supported by the Collaboration Secretariat. Secretariat Secretariat is currently based in the UK.
  • Centres The work of Collaborative Review Groups, Methods Groups, Fields, and the Consumer Network is facilitated in a variety of ways by the work of a dozen Cochrane Centres around the world (Australia, Brazil, Canada, China, Denmark, Germany, Italy, the Netherlands, South Africa, Spain, UK, and the USA).
  • They share responsibility for helping to co-ordinate and support members of the Collaboration in areas such as training, and they promote the objectives of the Collaboration at national level.
  • Collaborative Review Groups The main work of The Cochrane Collaboration is done by fifty two Collaborative Review Groups, within which Cochrane Reviews are prepared and maintained. The members of these groups, researchers, healthcare professionals, people using the health care services (consumers), and others, have come together because they share an interest in generating reliable, up-to-date evidence relevant to the prevention, treatment and rehabilitation of particular health problems or groups of problems. To become part of The Cochrane Collaboration, each Collaborative Review Group is required to prepare a plan outlining how it will contribute to the Collaboration's objectives. This describes who will have responsibility for planning, co-ordinating, and mentoring the Group's work (a co-ordinating editor supported by an editorial team). It also describes how the Group will identify and assemble in a specialized register as high a proportion as possible of all the studies relevant to its declared scope; and who, drawing on the studies in this register, will take responsibility for preparing and maintaining which reviews. Every Group appoints an individual to organise and manage the day-to-day activities of the Group, a review group coordinator.
  • More than 11,000 volunteer review authors produce the majority of the Cochrane Reviews through the Review Groups Of the 52 review groups in the collaborative, Canada hosts 5 of them. Within Canada over the past decade and more – many have recognized the value if the Cochrane work, and have joined in to assist: there are 17 Universities committed to the Centre’s work and one regional health Authority on board. 22 affiliated orgainzations. It is catching on!
  • 16 16
  • Fields Fields focus on dimensions of health care other than health problems, such as the setting of care (e.g. primary care), the type of consumer (e.g. children), or the type of intervention (e.g. vaccines). People associated with Fields search specialise sources for relevant studies, help to ensure that priorities and perspectives in their sphere of interest are reflected in the work of Collaborative Review Groups, compile specialized databases, co-ordinate activities with relevant agencies outside the Collaboration, and comment on systematic reviews relating to their particular area.
  • Methods Groups For example, the Statistical Methods Group is assessing ways of handling different kinds of data for statistical synthesis, and the Applicability and Recommendations Methods Group is exploring important questions about drawing conclusions regarding implications for practice, based on the results of reviews.
  • Consumer Network The Cochrane Consumer Network provides information and a forum for networking among consumers involved in the Collaboration, and a liaison point for consumer groups around the world.
  • Located at the 16 health sciences centres across the country, plus 2 additional sites - Recruit and support people new members of Cochrane - Promote local and regional awareness
  • A systematic review should be as transparent as possible and include as much of the above information as the publication medium allows.
  • for Epinephrine for bronchiolitis versus for Oral rehydration therapy versus intravenous therapy for gastroenteritis for in Inhaled nitric oxide for respiratory failure in preterm infants
  • With Cochrane, you are working with Review groups right from the beginning Search strategy
  • Once you’re title has been accepted…
  • How does bias come into play?
  • Inclusion Criteria Types of studies Types of participants Types of interventions Types of outcome measures Search methods for identification of studies Electronic searches (R) Searching other resources (R) Grey literature (O) Handsearching (O) Reference lists (O) Correspondence (O) Data collection Selection of studies (R) Data extraction and management (R) Assessment of risk of bias in included studies (R) Data Analysis Measures of treatment effect (R) Unit of analysis issues (R) Dealing with missing data (R) Assessment of heterogeneity (R) Assessment of reporting biases (R) Data synthesis (R) Subgroup analysis and investigation of heterogeneity (R) Sensitivity analysis (R)
  • Cochrane does not allow commercial funding
  • Once your protocol has been published in the Cochrane Library…. Some people work on the review even before the protocol is published to get started as turnaround times vary from CRG to CRG.
  • All reviews in the Cochrane Library will have this format ‘ Plain language summary’ (Synopsis) - Summarize in style understood by consumers - Accessible on the internet (stand-alone document) 2 parts 1. Restate title: (256 characters) plain language stating participants, intervention and outcome 2. Body: (< 400 words) Importance : background, signs/symptoms, prevalence, intervention, rationale Main findings : easily understood numerical results, Adverse effects , Limitations ABSTRACTS 400 words Available on-line as stand-alone documents Target healthcare decision makers Structured Consistent with text, data, conclusions
  • e.g. the Appendices the exact search strings for all the databases for the search strategy for the review could go here
  • To ensure this, Cochrane authors grant the Collaboration world-wide licences for these activities, and do not sign over exclusive copyright to any journal or other publisher. A journal is free to request a non-exclusive copyright that permits it to publish and re-publish a review, but this cannot restrict the publication of the review by The Cochrane Collaboration in whatever form the Collaboration feels appropriate. To republish material published in the Cochrane Database of Systematic Reviews elsewhere, most particularly in print journals, authors must complete a ‘permission to publish’ form available in the Cochrane Manual ( www.cochrane.org/admin/manual.htm ), along with an explanation of the procedures to follow. Authors are strongly discouraged from publishing Cochrane reviews in journals before they are ready for publication in CDSR.
  • However, journals will sometimes insist that the publication of the review in CDSR should not precede publication in print. When this is the case, authors should submit a review for publication in the journal after agreement from their CRG editor and before publication in CDSR. Publication in print should not be subject to lengthy production times, and authors should not unduly delay publication of a Cochrane review either because of delays from a journal or in order to resubmit their review to another journal. To ensure this, Cochrane authors grant the Collaboration world-wide licences for these activities, and do not sign over exclusive copyright to any journal or other publisher. When this is the case, authors should submit a review for publication in the journal after agreement from their CRG editor and before publication in CDSR. Publication in print should not be subject to lengthy production times, and authors should not unduly delay publication of a Cochrane review either because of delays from a journal or in order to resubmit their review to another journal. Journals can also request revision of a review for editorial or content reasons. External peer review provided by journals may enhance the value of the review and should be welcomed. Authors are also encouraged to add the following statement to versions of Cochrane reviews that are published in journals: ‘ This paper is based on a Cochrane review first published [or most recently substantively amended, as appropriate] in The Cochrane Library YYYY, Issue X (see www.thecochranelibrary.com for information). Cochrane reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and The Cochrane Library should be consulted for the most recent version of the review.’ The following modification of the disclaimer published in The Cochrane Library should be added to Cochrane reviews published in journals.
  • A new group formed within Cochrane to address this – coming up with new info/guidelines When registering a review with the Cochrane Collaboration, authors agree to keep it up-todate. This entails repeating, at periodic intervals, the steps involved in the original review. Some of the steps will require minimal effort (e.g. reviewing the research question to make sure it is still relevant) while others may require a substantial investment of time. Occasionally, review authors may decide to include a new analysis strategy in their updated review; for example, using statistical methods not previously available in RevMan. In general, new analysis strategies will represent substantive changes that merit editorial critique through the CRG's established editorial process. How often reviews need updating will vary depending on the production of valid new research evidence. Review authors should work with their editorial team to establish guides addressing when new research evidence is substantive enough to warrant a major update or amendment. The dates of such amendments must be recorded in the What’s New section of the review. It is Collaboration policy that reviews should either be updated within two years or should have a commentary added to explain why this is done less frequently.
  • If newer researchers are interested in conduvting a systematic review, they may collaborate and assist current reviewers with the update or take over the review with permission from the authors.
  • CRG websites or methods guidelines
  • Diagnostic tests aim to reduce uncertainty about an individual's condition and aid in the diagnosis and detection of disease. A plethora of tests are available for almost every condition imaginable. Many tests exist to detect the same condition and new tests are being developed all the time. A perfect test would identify all patients with the target condition, without making mistakes, but perfect tests are rare and the users of a test wish to know how well the test discriminates between individuals who have the target condition and those who have not, also known as the diagnostic test accuracy. The accuracy of diagnostic tests is studied by comparing the results of the test under evaluation with the results of a test known to be very good (the reference standard) in the same patients/participants. Clinicians, policymakers and patients routinely face a range of questions regarding diagnostic tests. They want to know if testing improves outcome, would like to know what test to use, to purchase or to recommend in practice guidelines, and how to interpret the results of testing. Systematic reviews can help practitioners and decision makers in answering these questions, by summarising the available evidence and helping to explain differences among studies on the same question. As with elsewhere in science, systematic reviews and meta-analyses can be used to obtain more precise estimates, when small studies addressing the same test and study participant types in the same setting are summarised. This combination of studies needs to be done in as reliable a way as possible. For this reason, it needs to be systematic. Systematic reviews of test accuracy use a predefined and explicit methodology. Accuracy measures the ability of the test to distinguish between persons with and without the target condition. Good accuracy is desirable but is not the only information required to assess the effectiveness of a diagnostic test. To show that one test does more good than harm in terms of patient outcomes, one may require randomized controlled trials of test and treatment strategies.
  • Some registers have been coded in detail: For example: - Type of intervention (e.g. chemotherapy, endotherapy) - Study type (RCT or CCT) The RCT’s and CCT’s are kept and made available for use in systematic reviews Specifically designed searches can be performed on the register by the trial search coordinator, that will retrieve references relevant to your systematic review question This resource is available to all reviewers by contacting the Trial Search Coordinator for the applicable CRG
  • Each group may also collect items which are not relevant to its own field of interest; these are known as ‘Handsearch Results’. The registers and handsearch results are assembled and collated by Wiley before incorporation into the Cochrane Central Register of Controlled Trials in The Cochrane Library . We often handsearch the last five years of one or two key conference proceedings in the subject area of the review.
  • Determining the focus of the review by defining the question is one of the most important steps in conducting a systematic review Guides the rest of the review from developing the search strategies; selecting studies; identifying the data to be extracted; analysing variation among results Allows potential readers to judge whether the review is interesting or relevant to their issues or interests Where do questions come from? Questions arise constantly from routine clinical practice; the introduction of new treatments or diagnostic tests should always lead to the question “ are they better than what we already have”; also get ideas from future research or future directions sections of existing reviews Taking the time to define the question through consultation with co-reviewers and the your Cochrane Review Group will pay dividends by avoiding wasted time and effort in conducting your review and will increase the chance that the review is scientifically and clinically meaningful
  • Focus on the best available evidence – for addressing questions regarding therapeutic efficacy is a randomized controlled trial For other questions, for examples studies of diagnostic accuracy tests, cohort studies may be more appropriate or realistic This is something you should consider up front – what study designs are likely to provide reliable data with which to answer their questions Main problem with including non RCT is that they are at greater risk of bias than RCT particularly the lack of control of unknown or unmeasured confounders

Cochrane Library Training Cochrane Library Training Presentation Transcript

  • The Cochrane Library: Train the Trainer for Health Librarians Canadian Cochrane Network & Centre Tamara Rader, MLIS Cochrane Musculoskeletal Group Institute of Population Health, University of Ottawa
  • Canadian Cochrane Network and Centre (CCNC) Funding Organizations Canadian Institutes of Health Research including 6 CIHR Institutes CADTH
  • Outline of the workshop
    • Session 1: Introductions and Background
    • Session 2: Cochrane and Systematic Reviews
    • Break
    • Session 3: The Cochrane Library
    • Session 4: On-line Demonstration
    • Break
    • Session 5: Small group work
    • Session 6: Wrap up and evaluation
  •  
  • Session 1: Introductions and Background
  • Introductions
    • Name
    • Background/previous experience
    • Have you ever used the Cochrane Library before?
    • Are you likely to be searching the Cochrane Library for your clients or teaching them to search?
  • Session 2: Cochrane and Systematic Reviews
  • The problem: information overload…
  • The solution: systematic reviews
  • Evidence-based Practice Evidence-based Decision Making Evidence/Information Expertise or experience Values, preferences, needs - from research - highest quality - past experience - own judgement - usually patient perspective - based on priorities in life, health beliefs Decision-making in health care
  • What is “evidence”?
    • Cohort studies
    • Case control studies
    • Cross sectional surveys
    • Case reports
    • Clinical trials
    • Randomized controlled trials
    • Reviews
    • Systematic reviews
  • Why don’t doctors use evidence in practice?
    • Lack of information management
    • Need to put results into context
    • Individual studies may be misleading
  • Problem of information management
    • Over 20,000 medical journals published per year
    • Published research of variable quality and relevance
    • Health care professionals often poorly trained in critical appraisal skills
    • Average time professionals have available to read = <1 hour/week
  • Need to put results into context
    • The results of individual studies need to be interpreted alongside the totality of evidence (systematic reviews)
    • Emphasis on individual studies may distract us
  • Individual studies may be misleading
    • 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
    • 49 reported evaluations of health care interventions; 45 claimed that the interventions were effective.
    • By 2004 5/6 non randomised studies and 9/39 randomised trials were already contradicted or found to be exaggerated
      • Ioannidis JP. JAMA 2005
  • What do we need to manage the flow of information, keep it in context, and not be mislead by individual studies?
  • Systematic reviews!
  • “ It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomized controlled trials”. Archie Cochrane, 1979
  • Collaboration’s Mission Statement The Cochrane Collaboration is a unique worldwide organization that aims to help people make well informed decisions about health care by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of health care interventions. www.cochrane.org
  • Why not other types of reviews?
    • Are a collection of material on a given subject
    • Looks at all studies on a specific topic (treatment, correct way to diagnose, prevention)
    • Two ways to review literature: Narrative or Systematic
  • What are the different review types? Type: Feature: Scoping Literature Review Narrative Question What is known about a topic What is known about a topic Broad Search strategy Unknown Unknown Not known Selection of studies Known, but post hoc Unknown Not known Inferences Thematic, makes comparisons Descriptive May be based on evidence Advantages Rapid appraisal, identifies research gaps Maps what is known Breadth, historical, phenomena
  • NARRATIVE VS SYSTEMATIC
    • equal weight of studies High quality studies and weighted
    • General overview Focused question
    ?Search strategy Methodical and reproducible search ?assessment of studies Quality & relevance assessed ?bias Impartial and relevant results
  • 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.
    • Cochrane Collaboration (2005) Glossary of Terms in The Cochrane Collaboration
  • Systematic Reviews
    • Why a review could be undertaken:
      • ● Resolve conflicting evidence
      • ● Uncertainty in practice
      • ● Variations in practice
      • ● Confirm appropriateness of current practice
      • ● Highlight need for future research
  • Advantages of Systematic reviews
    • Reduce bias
    • Reduce random error
    • Explore variability
    • Provide reliable basis for making decisions
    • Inform and influence future research
  • Why Cochrane Reviews?
    • Effects of healthcare interventions, now also diagnostics
    • Summarize evidence and help people to understand
    • Careful not to impose own values, preferences, local context
    • Keep audience in mind while writing
    • All have the same structured format
    • Protocol -> Review
  • The strength of a Cochrane review
      • ● Rigour of methodology
      • ● Broad scope of literature included
      • ● Updated and maintained
      • ● Inclusiveness of perspectives
      • ● Plain language summary
      • ● Independence from commercial interests
  • Cochrane Review - unique Grey & published, in all languages Systematic manual searches of key journals Computerized Databases Review of reference lists Consultation with experts Identify Studies Review for Relevance Not Relevant Relevant Reject Critical appraisal Extract Data Analyze Data Conclusions Plain language summary Updates
  • Steps of a Cochrane review
      • STEP 1 : formulate the problem, assemble review team,
      • and register the title with Review Group
      • STEP 2 : write protocol, submit for peer review, and
      • publish on Cochrane Library
      • STEP 3 : conduct the Review, publish on Cochrane Library
            • locate and select studies
            • data collection: study characteristics, risk of bias, outcome data, other information analyse and present results
            • interpret results and write review
      • STEP 4 : update review
  • Review Submission If no review, registered title becomes available to others Guidelines for Protocol and Review Process Updating ~ 2 years 6 Months Title Registration Approval of title by Editorial Board Protocol Submission If no protocol, registered title becomes available to other interested reviewers 1.5 Years
  •  
  • Advantages of authoring a Cochrane review
      • Credibility - independence from commercial interests
      • Learn critical appraisal skills
      • Participate in developing systematic review methods
      • International exposure in Cochrane Library
      • Clinically relevant reviews incorporated into many derivative clinical tools based on Cochrane reviews
  • Advantages of authoring a Cochrane review
      • Protocols developed for increasing transparency and reducing bias
      • Peer review process
  • Review Team
    • Two or more people
      • For methods
      • Range of Expertise depending on Review Group
      • ◊ Content
      • ◊ Methodology (including statistical)
      • ◊ Searching (Trials Search Coordinator)
      • ◊ Translation
      • ◊ International (encouraged)
      • ◊ Others – varied regions, settings, consumers
    Commitment to the life of the Review!
  • Impact of Cochrane Evidence
    • Cochrane reviews have become known internationally as sources of high quality, reliable health information
    • The dissemination of Cochrane evidence: an inventory of resources that use Cochrane reviews http://209.211.250.105/reviews/impact/dissemination.htm
    • Press releases by the publisher of The Cochrane Library http:// www.cochrane.org/press/releases.htm
    • Impact Factor: Impact Factor: The 2008 impact factors have now been published by Thomson ISI. The Cochrane Database of Systematic Reviews has an Impact Factor of 5.182 and is ranked 12th out of 107 in the ISI category Medicine, General & Internal.
    Source: http:// www.cochrane.org /reviews/impact/
  • Recent Cochrane Reviews in the Press
  • 20 minute Break!
  • Session 3: The Cochrane Library
  • www.thecochranelibrary.com New Editor-in-Chief: Dr. David Tovey
  • What is The Cochrane Library?
    • Main output of Cochrane Collaboration
    • A collection of databases
      • Contains Cochrane reviews & other databases
    www.thecochranelibrary.com Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • What is the Cochrane Library?
    • “ The Cochrane Library brings together in one place research which looks at the effectiveness of different health care treatments and interventions. It is recognised as the best single source of information on the effects of health care.”
      • NICs Guide to the Cochrane Library, Australian Cochrane Centre
  • Who publishes it?
    • Wiley-Blackwell
      • on behalf of The Cochrane Collaboration
      • under contract
      • Available on CD Rom and the Internet
        • www.thecochranelibrary.com
    Carol Lefebvre. The Cochrane Library – an update , Wiley Sunrise Seminar. MLA, Honolulu, Hawaii, 18 May 2009.
  • How often is the Cochrane Library updated?
    • updated and expanded every 3 months or quarterly
  • Why do we need the Cochrane Library?
    • To assist clinicians in keeping up with major developments
    • To help consumers weigh the potential benefits and harms of treatment
  • The Cochrane Library: the databases
    • Cochrane Database of Systematic Reviews
      • (CDSR; Cochrane Reviews) 5,785
    • Database of Abstracts of Reviews of Effects
      • (DARE; Other Reviews) 9,964
    • Cochrane Central Register of Controlled Trials
      • (CENTRAL; Clinical Trials) 575,975
    • Health Technology Assessment Database
      • (HTA; Technology Assessments) 7,717
    • NHS Economic Evaluation Database
      • (NHSEED; Economic Evaluations) 25,255
    • Cochrane Methodology Register
      • (CMR; Methods Studies) 11,572
    Carol Lefebvre. The Cochrane Library – an update , Wiley Sunrise Seminar. MLA, Honolulu, Hawaii, 18 May 2009.
  • Who Provides the Content?
    • Cochrane Database of Systematic Reviews
    • Database of Abstracts of Reviews of Effects
    • Cochrane Central Register of Controlled Trials
    • Cochrane Methodology Register
    • Health Technology Assessment Database
    • NHS Economic Evaluation Database
  • Structure of the Cochrane Collaboration Cochrane Database of Systematic Reviews Database of Abstracts of Reviews of Effects Cochrane Central Register of Controlled Trials* Cochrane Methodology Register Health Technology Assessment Database NHS Economic Evaluation Database *Specialized registers are added into Cochrane Central Register of Controlled Trials (Central) The Cochrane Library
  • Structure of the Cochrane Collaboration Cochrane Database of Systematic Reviews Database of Abstracts of Reviews of Effects Cochrane Central Register of Controlled Trials* Cochrane Methodology Register Health Technology Assessment Database NHS Economic Evaluation Database Structure of the Cochrane Collaboration *Specialized registers are added into Cochrane Central Register of Controlled Trials (Central) The Cochrane Library
  • The Cochrane Database of Systematic Reviews (CDSR)
    • The database that contains all the Cochrane Reviews
    • Issue 2 2009
      • 3826 complete Cochrane reviews and
      • 1959 protocols (reviews in progress)
      • in html & PDF format
  • What is special about CDSR?
    • up-to-date overviews of existing evidence
    • higher quality than other systematic reviews (but …)
    • reviews updated with new studies / improved methods
    • amended / updated from comments and criticisms
      • pre- and post-publication
    Adapted from Carol Lefebvre. The Cochrane Library – an update , Wiley Sunrise Seminar. MLA, Honolulu, Hawaii, 18 May 2009.
  • Why Use the Wiley Version of the CDSR?
    • Can search the full text of a review
      • Except for the references
    • Access to the full text
      • PDF or HTML
    • Can browse by
      • New Reviews
      • Updated Reviews
      • All Review – Protocols and Full Reviews
    • Protocols not available in PubMed
    • Can easily export a citation
  • Cochrane Central Register of Controlled Trials (CENTRAL)
    • c. 580,000 reports of RCTs and other controlled trials
      • 330,000 from MEDLINE
        • (all records indexed as RCT or CCT in PT in humans)
      • 90,000 additional reports of trials from searching EMBASE
      • 160,000 reports of trials from handsearching journals / conference abstracts
    Adapted from Carol Lefebvre. The Cochrane Library – an update , Wiley Sunrise Seminar. MLA, Honolulu, Hawaii, 18 May 2009.
  • What is special about CENTRAL?
    • unique!
    • best single source of reports of randomized controlled trials
    Carol Lefebvre. The Cochrane Library – an update , Wiley Sunrise Seminar. MLA, Honolulu, Hawaii, 18 May 2009.
  • What’s new in Cochrane
    • Summary of Findings Tables
      • see Reviewers’ Handbook Chapter 11.5
    • Risk of Bias Tables
      • see Reviewers’ Handbook Chapter 8.6
      • http://www.cochrane-handbook.org /
    • Diagnostic test accuracy reviews
      • http:// srdta.cochrane.org/en/index.html
    Carol Lefebvre. The Cochrane Library – an update , Wiley Sunrise Seminar. MLA, Honolulu, Hawaii, 18 May 2009.
  • What’s new in Cochrane
    • Editor-in-Chief appointed late 2008
      • David Tovey former Editorial Director of the BMJ Group’s “Knowledge” division, responsible for BMJ Clinical Evidence and its sister product BestTreatments
    • Podcasts and other multimedia
      • Podcasts from the most-accessed Cochrane reviews
        • http:// www.cochrane.org/podcasts/index.html
    • Colloquium presentations as videos, slidecasts
    • RSS newsfeeds from The Cochrane Collaboration
    • Facebook
    • Twitter - http://twitter.com/cochranecollab
    Carol Lefebvre. The Cochrane Library – an update , Wiley Sunrise Seminar. MLA, Honolulu, Hawaii, 18 May 2009.
  • Cochrane Reviews - Improved Status Flags Carol Lefebvre. The Cochrane Library – an update , Wiley Sunrise Seminar. MLA, Honolulu, Hawaii, 18 May 2009.
  • Advanced search
    • F or greater flexibility choose the Cochrane Advanced Search
    • The Advanced Search screen allows you to build searches by combining several different concepts using Boolean operators (AND, OR or NOT) and lets you limit your search according to particular databases, types of record or year(s).
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • Boolean Logic
    • AND retrieves results that include all the search terms; u se AND to narrow results by combining concepts
    • OR retrieves results that include at least one of the search terms; expanding possibilities of retrieval; u se OR to group synonymous terms together
    • NOT excludes the retrieval of terms from your search.
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • Boolean Operators Aquatic excercises osteoarthritis Aquatic exercises osteoarthritis Aquatic exercises osteoarthritis Aquatic exercises osteoarthritis Aquatic exercises osteoarthritis Aquatic exercises AND OR NOT osteoarthritis
  • Advanced search tips
    • Use wildcard truncation * to truncate a word (multiple characters), i.e. to search for multiple characters before, within, or after a search string.
    • E.g. aquatic NEXT exercis*, e.g. exercise, exercises, or exercising
    Janet Joyce, The Cochrane Library , Presentation for CAOT, CPA, CASLPA, April 22, 2008, Halifax
  • Advanced search tips
    • Use NEXT to find keywords adjacent to each other (proximity searching)
    • E.g. aquatic NEXT exercise
    • [Review] Aquatic exercise for the treatment of knee and hip osteoarthritis
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • Advanced search tips
    • Use NEAR with a number to indicate proximity of terms either before or after each other. The default proximity value for the operator when no number is used is 6.
    • E.g. aquatic NEAR exercise*
    • [Protocol] Aquatic therapy exercise for treating rheumatoid arthritis
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • Advanced search tips
    • Exact phrase search: Insert a term within quotation marks to create an exact match.
    • E.g. “water gymnastics”
    • The review found that specifically tailored strengthening exercise, sitting pelvic tilt exercise programs and water gymnastics all reported beneficial effects
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • Organizing the search….
    • PICO - A well-formulated question makes it easier to produce the strategy and find the evidence
    • Strategy will be based on controlled vocabulary ( Medical Subject Headings), and text words (develop list of key terms, synonyms)
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • Start with PICO P atient/ P opulation I ntervention C omparison O utcome Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • Framing the question
    • Are aquatic-exercise interventions in the treatment of knee and hip osteoarthritis effective and safe?
    • In patients with knee or hip osteoarthritis ( population )
    • Are aquatic-exercise interventions ( intervention )
    • No comparator ( comparison )
    • Effective and safe? ( outcome )?
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • PICO
    • Patient group
    • Knee osteoarthritis
    • Hip osteoarthritis
    • Intervention
    • Aquatic exercise interventions
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • PICO
    • Patient group
    • osteoarthritis, knee (MeSH)
    • osteoarthritis, hip (MeSH)
    • (osteoarthritis OR osteoarthros*) AND (knee OR hip)
    • Intervention
    • hydrotherapy (MeSH)
    • balneology (MeSH)
    • swimming (MeSH)
    • balneotherap*
    • aquatic NEXT exercis*
    • (aquatic OR water) NEXT sport*
    • pool NEXT therap*
    • water NEXT aerobic*
    • water NEXT exercis*
    • water NEXT run*
    • water NEXT training
    • water NEXT gymnastic*
    • (water* OR aquatic OR pool) AND physiotherapy
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • Resources for Customized Searching
    • Select Cochrane Central Register of Controlled Trials
    • Search for the following codes in “All Text” and
      • Language Codes
        • http:// www.nlm.nih.gov/bsd/language_table.html
      • Review Group Register Codes
        • http://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/CENTRALHelpFile.html#app
  • Managing References
    • Bibliographic software
      • Reference Manager, EndNote, Procite, RefWorks, etc.
      • Direct export is available for many databases
      • Useful for importing references from multiple databases and removing duplicates
      • Compatible with RevMan
    Janet Joyce, The Cochrane Library , Presentation for CAOT, CPA, CASLPA, April 22, 2008, Halifax.
  • Staying Current
    • http:// www.cochrane.org/news/index.shtml
      • New Cochrane Reviews
      • Podcasts of new reviews
      • Cochrane in the News
      • Cochrane Workshops
      • Cochrane Press Releases
      • Cochrane on Facebook
      • Cochrane on Twitter
  • Different types of research questions
    • What are the benefits and harms of treatment ‘X’ in animal models?
    • What are the benefits and harms of treatment ‘X’ in humans?
    • What are the benefits and harms of a new service delivery configuration?
    • What are the benefits and harms of a quality improvement initiative?
    • What is the accuracy of a diagnostic text ‘X’?
  • Different types of research questions
    • (continued)
    • What is the accuracy of routine coding following hospital discharge?
    • What are the experiences of patients undergoing treatment ‘X’?
    • What is the prevalence of condition ‘X’?
    • How strong is the association between gene ‘A’ and disease ‘X’?
    • … and more!
  • When would you search the Cochrane Library?
    • What is the effective treatment of y?
    • What is the effective treatment of y in condition x?
    • Is treatment y better than treatment z?
    • What is the accuracy of a diagnostic text ‘x’?
    Boagey, Paul. Using the Cochrane Library. University of Southampton Library, November 2007. http://www.soton.ac.uk/library/subjects/sonm/pptcochranenov2007.ppt
  • When NOT to use the Cochrane Library
    • General health care information: prognosis, causal, epidemiology...
    • Statistics: incidence and prevalence
    • Needs assessment studies
    Boagey, Paul. Using the Cochrane Library. University of Southampton Library, November 2007. http://www.soton.ac.uk/library/subjects/sonm/pptcochranenov2007.ppt
  • Session 4: On-Line Demonstration
  • The Cochrane Library has many features that make finding the information you are after fast and accurate…
  • “ searching for all text schizo, drugs, atypical and antipsychotic. in All Fields in The Cochrane Database of Systematic Reviews &quot; An Advanced Search of The Cochrane Library…
  • … Returns the following results: You can toggle between results listed for the different databases in The Cochrane Library here Use these links to restrict your search results to Reviews only, or Protocols (reviews in progress) only. Save or edit your search using these links.
  • MeSH (Medical Subjects Heading Search) Let us look at an example MeSH search
  • Use the Thesaurus to search for MeSH descriptors MeSH (Medical Subjects Heading Search)
  • Or use qualifiers. MeSH (Medical Subjects Heading Search)
  • Search History Select Search History to combine searches, enter their number together with Boolean operator of choice (AND, OR, NOT).
  • Combine searches by entering their number together with Boolean operator of choice (AND, OR, NOT). Search History
  • Search History
  • Your combined search will then appear in your Search History. Search History
  • 15 minute Break!
  • Session 5: Small Group Work www.thecochranelibrary.com
  • Case Studies
    • Read the case study provided
    • Formulate the question
    • Experiment with the search features of the Cochrane Library & try and find a suitable review or other paper to address the question
    • Repeat with the case on the reverse!
  • Session 6: Wrap up and Evaluation
  • Workshop planning
    • Practical issues
    • Programme issues
    • Evaluation issues
    • Equipment
    • Training materials
    • On the day...
    Irene Wiik & Lena Nordheim. How to plan a finding the evidence workshop. Nordic Baltic EAHIL Workshop. Powerpoint. June 26, 2003 Oslo, Norway. http:// www.eahil.net/conferences/oslo/programme.htm
  • Teaching methods
    • Classroom approach
    • Interactive:
      • Small groups
      • Intermediary tasks
      • Hands-on
    • A mix of both approaches
    Irene Wiik & Lena Nordheim. How to plan a finding the evidence workshop. Nordic Baltic EAHIL Workshop. Powerpoint. June 26, 2003 Oslo, Norway. http:// www.eahil.net/conferences/oslo/programme.htm
  • Cochrane Library User Training Resources
    • http://www.cochrane.org/resources/clibtrain.htm
  • Cochrane Library Training Materials
    • www.thecochranelibrary.com
      • see under Help! (New Users Start Here)
    • Brochures
    • E-learning modules
    • Online help manual
    • Quick reference guides
    • User guides
    • Dates and Statuses explained
    • Help file for CENTRAL (Creation Details)
    • WebEx
    Carol Lefebvre. The Cochrane Library – an update , Wiley Sunrise Seminar. MLA, Honolulu, Hawaii, 18 May 2009.
  • Cochrane Library Online Modules
    • The Cochrane Library – Module 1
      • (8 minutes)
      • www.brainshark.com/wiley/cochrane1
    • Tips on Advanced and MESH searching – Module 2
      • (7 minutes)
      • www.brainshark.com/wiley/cochrane2
    • Setting up Saved Searches and e-mail Alerts – Module 3
      • (7 minutes)
      • www.brainshark.com/wiley/cochrane3
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • Cochrane Library Tutorial
    • The Cochrane Library on Wiley InterScience User Guide Version 2.2
      • http://www3.interscience.wiley.com/homepages/106568753/userguide.pdf
  • Training Ideas
    • Fill out the back of your evaluation form
  • The Cochrane Library Users’ Group
    • Offers:
    • Answers from the experts
    • A forum for information-sharing
    • An opportunity for feedback
    • To get involved:
    • www.CLUG.iwh.on.ca
    • Or contact Emma Irvin [email_address]
  • Cochrane for Librarians
    • The Cochrane Information Retrieval Methods Group
      • http:// www.irmg.cochrane.org/en/index.html
    • Have your say!
    Carol Lefebvre. The Cochrane Library – an update , Wiley Sunrise Seminar. MLA, Honolulu, Hawaii, 18 May 2009.
  • Contributions to slides
    • Cochrane Centre staff
    • Emma Irvin (IWH)
    • Victoria Pennick, Managing Editor, Cochrane Back Review Group
    • Doug Salzwedel, Cochrane Hypertension Group
    • Margaret Sampson, Children's Hospital of Eastern Ontario (CHEO)
    • Dr. Jill Hayden, Cochrane Network Site rep at Dalhousie University (stakeholder slide)
    • Carol Lefebvre, UK Cochrane Centre, Oxford University
    • Kate Light, NHS Centre for Reviews and Dissemination, York University
    • Donna Dryden, Lisa Hartling and Carol Spooner, Alberta Research Centre for Health Evidence (ARCHE)
    • Paul Boagey, Unversity of Southamptom Library, UK
    • Irene Wiik & Lena Nordheim, Norwegian Directorate for Health and Social Affairs
  • Questions?
    • Tamara Rader, MLIS Knowledge Translation Specialist Cochrane Musculoskeletal Group [email_address]
    • Mary Ellen Schaafsma Canadian Cochrane Centre Institute of Population Health Phone: (613) 562 5800 x5224 Fax: (613) 562 5659 Email: [email_address] Web: www.ccnc.cochrane.org
  • Thank you!
  • The Cochrane Collaboration
    • Structure - established as an international organisation in 1993, registered as a charity in the U.K.
    • Aim - to help people make well-informed decisions about health care.
    • How - by preparing and promoting access to systematic reviews of the effects of healthcare interventions.
    • Publishing Output – The Cochrane Library
  • Levels of evidence, variable quality Research users (consumers, health care professionals and policy makers) often poorly trained in critical appraisal skills
  • What is a Randomized Controlled Trial (RCT)
    • Randomised controlled trials are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and for assessing the cost effectiveness of a treatment.
    Bonnie Sibbald and Martin Roland. Understanding controlled trials: Why are randomised controlled trials important? BMJ, Jan 1998; 316: 201.
  • What is a Randomized Controlled Trial (RCT) Evans, Jennifer. Figure 1 Design of a Randomised Controlled Trial In: Epidemiology in Practice: Randomised Controlled Trials. J Comm Eye Health, 1998;11(26) 27. http://www.cehjournal.org/download/ceh_11_26_026.pdf
  • The Cochrane Collaboration
  • Centres 13 Networks Methods Groups 13 Fields 16 Steering Group Structure of The Cochrane Collaboration Review Groups 52
  • Structure of the Cochrane Collaboration Source: http://www.cochrane.org/resources/leaflet2of5structure.htm
  • Steering Group
    • Made up of representatives from all sectors of the Collaboration
    • Meets twice a year
    • Develops policies and strategies for the Collaboration
    • Is supported by the Collaboration Secretariat
    Steering Group
  • Cochrane Centres
  • Cochrane Centres
    • Promote awareness of The Cochrane Collaboration
    • Support The Cochrane Collaboration on a
    • geographical basis
    • Help coordinate and support members
    • e.g. education & training
    • Establish partnerships
    Centres
  • Canadian Cochrane Centre
    • Director – Jeremy Grimshaw
    • Executive Director – Mary Ellen Schaafsma
    • Knowledge Broker – Cheryl Arratoon
    • Education Coordinator – Adrienne Stevens
    • Communications Specialist – Jeanette Doucet
    • Administrative Assistant – Lisa McGovern
    • Policy Liaison Initiative – John Lavis,
    • Lori Greco (McMaster site)
    • Email: [email_address]
  • Cochrane Review Groups
    • International group of experts with an interest in a health problem area
    • Prepare and maintain systematic reviews on
      • Treatment of Disease of Health Problems
      • Assessment of Diagnostic Tests
      • Methodology of Systematic Reviews
    • Willing and able to review all relevant research on specified health care problems
    CRGs
    • Back Review Group
    • Effective Practice and Organization of Care RG
    • Hypertension Review Group
    • Inflammatory Bowel Disease and Functional Bowel Disorders Review Group
    • Musculoskeletal Review Group
    Cochrane Review Groups Worldwide there are 52 registered review groups, 5 of which have their editorial base in Canada
  • Cochrane Review Group Products
    • Systematic Reviews
      • these are published in The Cochrane Library in the Cochrane Database of Systematic Reviews
    • Specialised Registers
      • These get incorporated into the Cochrane Central Register of Controlled Trials in The Cochrane Library
    CRGs
  • Cochrane Fields
    • Represent a population, group, or type of care that overlaps multiple review group areas
      • E.g., primary care, health care of older people
    • Ensures their priorities are reflected in the work of Review Groups
    • Child Health Field
    • Health Equity Field
    Fields
    • Cochrane Methods Groups
    • Develop methodology and advise the Collaboration on how the validity and precision of systematic reviews can be improved
    • e.g.. Statistical methods, non-randomized studies, information retrieval
      • Bias Methods Group
    Methods
  • The Cochrane Consumer Network
    • Supports the role of consumers within Cochrane
    • Provides information and a forum for networking among consumers involved in the Collaboration
    • Facilitates the dissemination of information to patients & families
    http:// www.cochrane.org/consumers/homepage.htm Consumer Network
  • Canadian Cochrane Network
  • Canadian Cochrane Centre Affiliates
    • 22 healthcare professional, research, and patient organizations
    • Advise CCNC on future directions and activities
    • Promote the awareness, appreciation, distribution, and use of Cochrane reviews among their members
  • Affiliate Organizations - sample
  • Key Characteristics of a Systematic Review
    • Clearly stated title and objectives for the review
    • Comprehensive strategy to search for studies that address the objectives of the review (relevant studies) to include unpublished as well as published studies
    • Explicit and justified criteria for the inclusion or exclusion of any study
    • Comprehensive list of all studies identified
    • Clear presentation of the characteristics of each study included and an analysis of methodological quality
    • Comprehensive list of all studies excluded and justification for exclusion
    • Clear analysis of the results of the eligible studies using statistical synthesis of data (meta-analysis) if appropriate and possible
    • Sensitivity analyses of the synthesised data if appropriate and possible
    • Structured report of the review clearly stating the aims, describing the methods and materials and reporting the results
    Kate Light, The Cochrane Library: Self Training Guide and Notes, 2003 Issue 4, Centre for Reviews and Dissemination, University of York, November 2003. http://toolkit.lrcnetwork.org/English/Training/Cochrane-Intro-Eng.pdf
  • Develop a Title
    • Turn PICO question into a declarative title
    • Should be specific and unambiguous
    • Should clearly state the focus of the review
    • Cochrane has standard formats
    Donna Dryden and Lisa Hartling. Defining the Question and Protocol Development . PowerPoint presentation. Author Training Workshop, Canadian Cochrane Symposium, Edmonton, Alberta, March 8, 2008.
  • Title Registration
    • Find Cochrane Review Groups (CRGs) relevant to your topic
      • http://www.cochrane.org/contact/entities.htm#CRGLIST
    • Avoid overlap and duplication
    • Registration form
    Donna Dryden and Lisa Hartling. Defining the Question and Protocol Development . PowerPoint presentation. Author Training Workshop, Canadian Cochrane Symposium, Edmonton, Alberta, March 8, 2008.
  • Step 2: The Protocol
  • Protocol Development
    • Framework for conducting review
      • Reviews are retrospective in nature
      • Want to minimize BIAS
    • Invest Time
      • The more you can identify up front, the more rigorous your review will be
    • Changes
      • Not completely avoidable
      • Highly susceptible to bias
      • Need to be documented and reported
    Donna Dryden and Lisa Hartling. Defining the Question and Protocol Development . PowerPoint presentation. Author Training Workshop, Canadian Cochrane Symposium, Edmonton, Alberta, March 8, 2008.
  • Protocol (continued)
    • Helps to avoid duplication of effort
    • Transparency and clarity are fundamental!
    • You want your review to be reproducible
    • Cochrane protocols published
    • Document changes between protocol and review!
  • Elements of a Protocol
    • Cover sheet
      • Title, citation details, contact addresses
    • Background
    • Objectives
    • Methods
      • Criteria for considering studies for the review
      • Primary and secondary outcome(s)
      • Search methods for identification of studies
      • Data collection
      • Data Analysis
    Donna Dryden and Lisa Hartling. Defining the Question and Protocol Development . PowerPoint presentation. Author Training Workshop, Canadian Cochrane Symposium, Edmonton, Alberta, March 8, 2008.
  • Other Elements of a Protocol
    • Acknowledgements
    • Contributions of authors
    • Declarations of interest
    • Sources of support
    • Tables and figures relevant to the background or methods
    • References
    Donna Dryden and Lisa Hartling. Defining the Question and Protocol Development . PowerPoint presentation. Author Training Workshop, Canadian Cochrane Symposium, Edmonton, Alberta, March 8, 2008.
  • Process
    • Cochrane Review Group (CRG) is involved for all steps
    • Review Manager (RevMan) software
      • http://www.cc-ims.net/RevMan
    • Appraisal by editorial staff at CRG
    • Protocol published in CDSR, then review published in CDSR when completed
    Donna Dryden and Lisa Hartling. Defining the Question and Protocol Development . PowerPoint presentation. Author Training Workshop, Canadian Cochrane Symposium, Edmonton, Alberta, March 8, 2008.
  • Step 3: Conducting the Review
  • Structure of a Full Cochrane Review
    • Plain-language summary
    • Structured Abstract
    • Background
    • Objectives
    • Selection Criteria
    • Search strategy for identification of studies
    • Methods of the review
    • Description of Studies
    • Methodological quality of included studies
    • Results
    • Discussion
    • Author’s Conclusions
    • Acknowledgements
    • References
  • Other Elements of a Cochrane Review
    • Supplementary information
      • Data and analyses
      • Appendices
    • About this article
      • Contributions of authors
      • Declarations of interest
      • Sources of support
      • Differences between protocol and review
      • Notes
  • Dissemination
    • Co-publication agreements have been made with several journals - see Handbook, section 2.4
    • Cochrane reviews must remain free for dissemination in any and all media, without restriction
    Carol Spooner. Completing Your Review. PowerPoint presentation. Author Training Workshop, Canadian Cochrane Symposium, Edmonton, Alberta, March 5, 2008.
  • Dissemination, cont.
    • Some Journals insist publication of the review in CDSR should not precede publication in print
    • In this case, authors should submit a review after agreement from CRG editor and before publication in CDSR
    Carol Spooner. Completing Your Review. PowerPoint presentation. Author Training Workshop, Canadian Cochrane Symposium, Edmonton, Alberta, March 5, 2008.
  • Step 4: Updating Your Review
  • Updating
    • Current recommendation
      • Every 2 years or when important new evidence available
        • if less - risk being out of date and misleading
        • if too frequent - may introduce a bias related to the slower publication of studies with negative and inconclusive results.
      • Know your subject area: anything new …
        • See Handbook section 10.5 for guidance
    Carol Spooner. Completing Your Review. PowerPoint presentation. Author Training Workshop, Canadian Cochrane Symposium, Edmonton, Alberta, March 5, 2008.
  • Henderson I. Craig, Wilcken N, Ghersi D, Davis N, Parker S, Carrick S. How to Read and Do a Cochrane Systematic Review . Leura V International Breast Cancer Conference, Sydney Australia, November 10-14, 2004. http://www.ctc.usyd.edu.au/cochrane/publications/presentations/CBCG%20-%20Leura%20V%20workshop%20November%202004.ppt Updates Draft Protocol peer review Draft review peer review Final Protocol Published on Cochrane Library Final review Published on Cochrane Library Perform review Identify studies, apply eligibility criteria, extract and analyse data Question registered
  • Resources for conducting a Cochrane review
    • www.cochrane.org
  • Additional Cochrane Resources
    • Review production resources for authors & managing editors http:// www.cochrane.org/resources/revpro.htm
    • Cochrane Handbook for Systematic Reviews of Interventions http:// www.cochrane.org /resources/handbook/ index.htm
    • Cochrane Collaboration open learning material for reviewers http://www.cochrane-net.org/openlearning /
    • Undertaking Systematic Reviews of Research on Effectiveness http://www.york.ac.uk/inst/crd/pdf/crdreport4_complete.pdf
    • RevMan homepage (Review Software) http://www.cc-ims.net/RevMan
  • What are systematic reviews of diagnostic test accuracy?
    • powerful tools for producing reliable and precise measures of the accuracy of a test for specific patient/participant group and setting
    • building reviews and summarizing study results can be methodologically challenging
    • information obtained from these reviews is useful for assessing the accuracy of a test or tests
    • evidence from randomized controlled trials of combined 'test and treatment' strategies, and reviews of such studies, are needed
    Source: http://www3.interscience.wiley.com/homepages/106568753/what_diagnostic.pdf
  • Specialized registers
  • What is a Specialized Register?
    • Most Review Groups maintain a trials register
    • Can be the primary source of studies for many systematic reviews
    • Each Review Group has a Trial Search Coordinator that compiles the register
    • Specialized registers are incorporated into The Cochrane Library at the discretion of the Trials Search Coordinator
  • Hand-searching
    • Hand-searching refers to the planned searching of a journal page by page including editorials, letters, etc., to identify all reports of randomized controlled trials
    • All Review Groups are responsible for handsearching journals and conference proceedings
    • Unique results are incorporated into their specialized register
  • Step 1: Defining the Question and Assembling the Review Team
  • Defining the Question
    • First and most important decision
      • Guides the rest of the review
      • End users’ determination of relevance
    • Take adequate time to draft and discuss with co-reviewers
    Donna Dryden and Lisa Hartling. Defining the Question and Protocol Development . PowerPoint presentation. Author Training Workshop, Canadian Cochrane Symposium, Edmonton, Alberta, March 8, 2008.
  • Broad vs Narrow Questions
    • Choice dependent on a number of factors:
    • Question’s relevance and potential impact
    • Supporting theoretical, biological, and epidemiological information
    • Generalizability and validity of answers
    • Available resources
    Donna Dryden and Lisa Hartling. Defining the Question and Protocol Development . PowerPoint presentation. Author Training Workshop, Canadian Cochrane Symposium, Edmonton, Alberta, March 8, 2008.
  • The Well-defined Clinical Question
    • P opulation
    • I ntervention
    • C omparator
    • O utcomes
    • S tudy Design
  • Study Designs
    • Most Cochrane reviews use RCTs as threshold
    • Some reviews/groups expand to other study designs
      • sometimes RCTs not appropriate
      • EPOC reviews include a variety of designs based on the interventions (e.g., mass media)
    • Don’t consider less rigorous study designs based on whether you think no RCTs have been done
    Donna Dryden and Lisa Hartling. Defining the Question and Protocol Development . PowerPoint presentation. Author Training Workshop, Canadian Cochrane Symposium, Edmonton, Alberta, March 8, 2008.
  • Question Format
    • Among…,
    • does…,
    • compared to…,
    • result in…?
    Donna Dryden and Lisa Hartling. Defining the Question and Protocol Development . PowerPoint presentation. Author Training Workshop, Canadian Cochrane Symposium, Edmonton, Alberta, March 8, 2008.
  • Review:
    • Name as many types of materials as you can that are found in The Cochrane Library
        • Protocols of systematic reviews
        • Systematic reviews
        • Health technology assessments
        • Randomized controlled trials
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • Review:
    • How would you approach finding what the Cochrane Library has on asthma?
      • Answer: Click on Cochrane by topics, airways (4 hits)
      • Answer: Click on by review group and choose airways (4 hits)
      • Simple search - asthma = There are 189 results out of 5320 records for: &quot;asthma in Title, Abstract or Keywords in Cochrane Database of Systematic Reviews&quot;
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • Searching….
    • Advanced search: “Search all text” =
    • Show Results in: Cochrane Reviews [473]   |   Other Reviews [212]   |   Clinical Trials [16160]   |   Methods Studies [85]   |   Technology Assessments [76]   |   Economic Evaluations [481]   |   Cochrane Groups [11]
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt
  • Searching….
    • MeSH searching: Enter asthma, and click on “Go to MeSH trees”; term occurs in 4 Tree structures (i.e._) and request all results
    • Results: Show Results in: Cochrane Reviews [111]   |   Other Reviews [133]   |   Clinical Trials [7304]   |   Technology Assessments [55]   |   Economic Evaluations [416] Here you are getting records in which a decision has been made that the topic includes Asthma
    Margaret Sampson. The Cochrane Library , CHLA, Halifax, May 30, 2008. http://www.library.ns.ca/files/Cochranetraining_0.ppt