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

    1. 1. Providing the Consumer Perspective: How to comment on Cochrane reviews and protocols Tamara Rader Cochrane Musculoskeletal Group March 6, 2008
    2. 2. Welcome! <ul><li>Introductions </li></ul><ul><li>Any questions? </li></ul>
    3. 3. Outline of workshop <ul><li>Background </li></ul><ul><li>The production of Cochrane reviews </li></ul><ul><li>Group work: Corticosteroid injection for trigger finger in adults. </li></ul><ul><li>Common concerns of consumers </li></ul><ul><li>Anything else? </li></ul>
    4. 4. The importance of your input <ul><li>consumers have expertise in the experience of the illness </li></ul><ul><li>they offer unique suggestions “from a strong knowledge base (often based on their personal experience and that of other health service users)” </li></ul><ul><li>consumers bring a new perspective and a fresh set of eyes </li></ul>
    5. 5. Evidence of the value of consumer input <ul><li>2006 Cochrane review looked at methods of consumer involvement that found: </li></ul><ul><li>Involving consumers to develop patient information improves its clarity and relevance; </li></ul><ul><li>telephone calls and face-to-face meetings may engage consumers more and change priority setting than mailed surveys </li></ul>
    6. 6. Why we like consumer opinions: <ul><li>Add value to the protocols and reviews </li></ul><ul><li>Help us save time by identifying priorities </li></ul><ul><li>Ultimately make the review more meaningful and relevant </li></ul><ul><li>Consumer opinions help fulfill one of the requirements of evidence-based health care </li></ul>
    7. 7. Evidence-Based Health Care Evidence/Information Expertise or experience Values, preferences, needs
    8. 8. 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>
    9. 9. 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>
    10. 10. 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>
    11. 11. 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>
    12. 12. 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>
    13. 13. 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>
    14. 14. 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>
    15. 15. 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
    16. 16. 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>
    17. 19. Writing Reviews Commenting on Reviews Editing Reviews Disseminating Reviews Searching for good studies Management
    18. 20. 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>
    19. 21. 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>
    20. 22. The production of Cochrane reviews <ul><li>Register the title </li></ul><ul><li>Write the protocol </li></ul><ul><li>Write the review </li></ul><ul><li>Update every 2 years </li></ul>
    21. 23. Steps in Production <ul><li>Identify and prioritize topics </li></ul><ul><li>to synthesize </li></ul>TITLE PROTOCOL REVIEW <ul><li>Plan how to synthesize 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, analyze and synthesize 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>
    22. 24. Preparing a Title TITLE <ul><li>evidence of value in identifying primary research topics, avoid duplication </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>
    23. 25. 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>
    24. 26. 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>
    25. 27. 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>
    26. 28. Common consumer concerns: <ul><li>“What is the difference between the abstract and synopses?” </li></ul><ul><li>The Synopses is aimed at consumers and the Abstract is aimed at practitioners and policy makers </li></ul><ul><li>Synopses is in plain language </li></ul><ul><li>Both follow a structured format </li></ul>
    27. 29. Consumer concerns continued… <ul><li>“This writing is unclear and I noticed some mistakes.” </li></ul><ul><li>Authors come from around the world, English may not be their first language. </li></ul><ul><li>Don’t worry about typos or grammar, reviews get copy-edited. </li></ul>
    28. 30. Consumer concerns continued… <ul><li>“This treatment is not available to me.” </li></ul><ul><li>Cochrane have world-wide coverage of treatments and some might be more common in other places. </li></ul><ul><li>Probably worthwhile to note the reason the treatment is not available: for example, not covered by insurance, too expensive, not part of normal care. </li></ul>
    29. 31. Consumer concerns continued… <ul><li>“Do I have to print all of it?” </li></ul><ul><li>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. </li></ul>
    30. 32. Consumer concerns continued… <ul><li>“I don’t understand this condition/intervention/statistic” </li></ul><ul><li>We try to give you reviews on topics you have experience or interest in </li></ul><ul><li>Review groups can offer help </li></ul><ul><li>It’s always fine to write that you don’t understand something, but even better if you can say why. </li></ul>
    31. 33. Consumer concerns continued… <ul><li>“Can I have some feedback on my comments?” </li></ul><ul><li>Feedback usually comes from the editor </li></ul><ul><li>We try to send the review to the consumer who did the protocol </li></ul><ul><li>As in peer review, authors must address each comment from the consumer </li></ul>
    32. 34. Consumer concerns continued… <ul><li>“I’m not feeling well, and I can’t comment in the near future” </li></ul><ul><li>Other ways to become involved </li></ul><ul><li>A larger pool of consumer reviews means that no one feels over burdened </li></ul>
    33. 35. Other tips: <ul><li>Be specific in your comments </li></ul><ul><li>Be practical, if you feel a major outcome is missing, suggest that it be added when the review is updated </li></ul><ul><li>Be constructive in your criticism. </li></ul>
    34. 36. Collaborative, not adversarial. <ul><li>Editors, authors, and consumers are all working toward the same goal. </li></ul>
    35. 37. Thank you! Tamara Rader 613-562-5800 Ext. 2397 [email_address]

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