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How to comment on a Cochrane review

How to comment on a Cochrane review






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  • Thank you for having me speak today – wonderful opportunity to meet you all in person. Also wonderful to have a chance to talk to you about access to information and libraries – an area that is becoming increasingly important to consumers.

How to comment on a Cochrane review How to comment on a Cochrane review Presentation Transcript

  • Providing the Consumer Perspective: How to comment on Cochrane reviews and protocols Tamara Rader Cochrane Musculoskeletal Group March 6, 2008
  • Welcome!
    • Introductions
    • Any questions?
  • Outline of workshop
    • Background
    • The production of Cochrane reviews
    • Group work: Corticosteroid injection for trigger finger in adults.
    • Common concerns of consumers
    • Anything else?
  • The importance of your input
    • consumers have expertise in the experience of the illness
    • they offer unique suggestions “from a strong knowledge base (often based on their personal experience and that of other health service users)”
    • consumers bring a new perspective and a fresh set of eyes
  • Evidence of the value of consumer input
    • 2006 Cochrane review looked at methods of consumer involvement that found:
    • Involving consumers to develop patient information improves its clarity and relevance;
    • telephone calls and face-to-face meetings may engage consumers more and change priority setting than mailed surveys
  • Why we like consumer opinions:
    • Add value to the protocols and reviews
    • Help us save time by identifying priorities
    • Ultimately make the review more meaningful and relevant
    • Consumer opinions help fulfill one of the requirements of evidence-based health care
  • Evidence-Based Health Care Evidence/Information Expertise or experience Values, preferences, needs
  • What is “evidence”?
    • Cohort studies
    • Case control studies
    • Cross sectional surveys
    • Case reports
    • Clinical trials
    • Randomized controlled trials
    • Reviews
    • Systematic reviews
  • 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
  • What do we need to manage the flow of information, keep it in context, and not be mislead by individual studies?
    • Reviews !
  • 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
  • Narrative Reviews of the Literature
    • Concerns:
      • Not focused
      • Studies excluded or missed
      • Inappropriate assessment of studies
      • Inappropriate comparison of studies
      • Author bias
  • What is a systematic review?
    • Systematic reviews are a way of synthesizing research evidence from many studies
    • Systematic reviews are a basic building block for planning future research
    • 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
  • Meta-analysis
    • The use of statistical techniques in a systematic review to integrate the results of included studies.
    • Cochrane Collaboration (2005) Glossary of Terms in The Cochrane Collaboration
  • Writing Reviews Commenting on Reviews Editing Reviews Disseminating Reviews Searching for good studies Management
  • People in Cochrane
    • Over 10,000 involved internationally
    • About 80 countries
    • Mostly volunteers
    • Diverse backgrounds, experience and expertise
  • People in Cochrane
    • Epidemiologists/Statisticians
    • Healthcare professionals
    • Consumers
    • Librarians
  • The production of Cochrane reviews
    • Register the title
    • Write the protocol
    • Write the review
    • Update every 2 years
  • Steps in Production
    • Identify and prioritize topics
    • to synthesize
    • Plan how to synthesize the studies
    • Identify why important to do this synthesis
    • Identify special groups to look at, benefits & harms to report, factors that might change the results
    • Write the protocol
    • Send protocol for comment
    • Edit protocol
    • Find, analyze and synthesize the studies
    • Interpret results and determine impact of findings
    • Write review
    • Send review for comment
    • Edit review
    • Publish Cochrane review
  • Preparing a Title TITLE
    • evidence of value in identifying primary research topics, avoid duplication
    • show the difference in what is done and what would like to see done
    • Challenges
    • not an emphasis
    • reviewer driven
    • individual bias or public consensus not known
  • Preparing a Protocol PROTOCOL
    • Value in recognizing all factors in studies that are relevant and important to people making health care decisions
    • Background, Participants, Interventions, Outcomes
    • Examples:
    • peer review of protocols
    • working with reviewers
  • Preparing the review REVIEW
    • value of consumers to determine meaning of the results to other consumers and put results in context
    • Challenges
    • knowledge of methods, analysis, limitations
    • time commitment (mutual) and recruitment
    • feedback and recognition
    • timelines
  • What is found in a Cochrane Review?
    • Consumer summary (Synopses, Plain Language Summary)
    • Abstract
    • Background
    • Objectives
    • Selection Criteria for studies
    • Search strategy
    • Methods of the review
    • Description of studies
    • Methodological qualities of included studies
    • Results
    • Summary of analyses
    • Conclusions
    • Potential conflict of interest
    • Acknowledgements
  • Common consumer concerns:
    • “What is the difference between the abstract and synopses?”
    • The Synopses is aimed at consumers and the Abstract is aimed at practitioners and policy makers
    • Synopses is in plain language
    • Both follow a structured format
  • Consumer concerns continued…
    • “This writing is unclear and I noticed some mistakes.”
    • Authors come from around the world, English may not be their first language.
    • Don’t worry about typos or grammar, reviews get copy-edited.
  • Consumer concerns continued…
    • “This treatment is not available to me.”
    • Cochrane have world-wide coverage of treatments and some might be more common in other places.
    • Probably worthwhile to note the reason the treatment is not available: for example, not covered by insurance, too expensive, not part of normal care.
  • Consumer concerns continued…
    • “Do I have to print all of it?”
    • You don’t have to print the references or characteristics of excluded studies. They probably aren’t necessary for you to give input into the review.
  • Consumer concerns continued…
    • “I don’t understand this condition/intervention/statistic”
    • We try to give you reviews on topics you have experience or interest in
    • Review groups can offer help
    • It’s always fine to write that you don’t understand something, but even better if you can say why.
  • Consumer concerns continued…
    • “Can I have some feedback on my comments?”
    • Feedback usually comes from the editor
    • We try to send the review to the consumer who did the protocol
    • As in peer review, authors must address each comment from the consumer
  • Consumer concerns continued…
    • “I’m not feeling well, and I can’t comment in the near future”
    • Other ways to become involved
    • A larger pool of consumer reviews means that no one feels over burdened
  • Other tips:
    • Be specific in your comments
    • Be practical, if you feel a major outcome is missing, suggest that it be added when the review is updated
    • Be constructive in your criticism.
  • Collaborative, not adversarial.
    • Editors, authors, and consumers are all working toward the same goal.
  • Thank you! Tamara Rader 613-562-5800 Ext. 2397 [email_address]