Cochrane Library Training

The Cochrane Library: Train the Trainer for Health Librarians

Canadian Cochrane Network & Centre

Tamara Rader, MLISCochrane Musculoskeletal Group

Institute of Population Health, University of Ottawa

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Canadian Cochrane Network and Centre (CCNC) Funding Organizations

Canadian Institutes of Health Researchincluding 6 CIHR Institutes

CADTH

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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

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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

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The problem: information overload…

The solution: systematic reviews

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Evidence-based PracticeEvidence-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 managementNeed 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?

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Systematic reviews!

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“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

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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 subjectLooks at all studies on a specific topic (treatment,

correct way to diagnose, prevention)Two ways to review literature: Narrative or Systematic

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What are the different review types?

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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

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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

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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

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Advantages of Systematic reviews

Reduce bias Reduce random error Explore variability Provide reliable basis for making

decisions Inform and influence future research

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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

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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

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Cochrane Review - uniqueGrey &

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 RelevantRelevant

Reject

Critical appraisal

Extract Data

Analyze Data

ConclusionsPlain language

summaryUpdates

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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 informationanalyse and present results

interpret results and write review

STEP 4: update review

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Review SubmissionIf no review, registered title becomes available

to others

6 Months

Title Registration

Approval of title by Editorial

Board

Protocol SubmissionIf no protocol, registered

title becomesavailable to other

interested reviewers

1.5 Years

Guidelines for Protocol and Review Process

Updating ~ 2 years

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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

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Advantages of authoring a Cochrane review

– Protocols developed for increasing transparency and reducing bias

– Peer review process

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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!

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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 reviewshttp://209.211.250.105/reviews/impact/dissemination.htm

Press releases by the publisher of The Cochrane Libraryhttp://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/

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Recent Cochrane Reviews in the Press

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20 minute Break!

Session 3:

The Cochrane Library

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www.thecochranelibrary.com

New Editor-in-Chief: Dr. David Tovey

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What is The Cochrane Library?

Main output of Cochrane Collaboration

A collection of databases– Contains Cochrane

reviews & other databases

www.thecochranelibrary.comMargaret Sampson. The Cochrane Library, CHLA, Halifax, May 30, 2008.http://www.library.ns.ca/files/Cochranetraining_0.ppt

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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

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Who publishes it?

Wiley-Blackwell – on behalf of The Cochrane Collaboration– under contract– Available on CD Rom and the Internet


Carol Lefebvre. The Cochrane Library – an update, Wiley Sunrise Seminar. MLA, Honolulu, Hawaii, 18 May 2009.

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How often is the Cochrane Library updated?

updated and expanded every 3 months or quarterly

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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

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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


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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



Cochrane Central Register of Controlled Trials*




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Structure of the Cochrane Collaboration

*Specialized registers are added into Cochrane Central Register of Controlled Trials (Central)


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Cochrane Central Register of Controlled Trials*




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*Specialized registers are added into Cochrane Central Register of Controlled Trials (Central)


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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

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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.

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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

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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.

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What is special about CENTRAL?

unique!

best single source of reports of randomized controlled trials


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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


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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


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Cochrane Reviews - Improved Status Flags

A full review, complete with results and discussion, possibly including meta-analyses to combine results across studies.

The outline of a review in preparation, including the background, rationale and methods.

A full-text systematic review of methodological studies.

A new protocol or review that has been published in the most recent issue (quarter).

A new search for studies has been conducted for an existing review as published in the most recent issue (quarter).

There has been an important change to the conclusions of the review as published in the most recent issue (quarter).

The protocol has been amended to reflect a change in scope as published in the most recent issue (quarter).

The review or protocol has been withdrawn, which may be because it was considered to be out of date. Reasons for withdrawal are specified in the document.

The review includes comments. Readers can submit comments, which are incorporated into the review together with answers and feedback from the review authors.


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Advanced search

For 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

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Boolean Logic

AND retrieves results that include all the search terms; use AND to narrow results by combining concepts

OR retrieves results that include at least one of the search terms; expanding possibilities of retrieval; use OR to group synonymous terms together

NOT excludes the retrieval of terms from your search.


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Boolean Operators

Aquatic excercises

osteoarthritis Aquatic exercises

osteoarthritis Aquatic

exercises




AND

OR

NOT

osteoarthritis

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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

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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


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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


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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


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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)


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Start with PICO

Patient/Population

Intervention

Comparison

Outcome


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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)?


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PICO

Patient groupPatient group

• Knee osteoarthritisKnee osteoarthritis• Hip osteoarthritisHip osteoarthritis

Intervention

• Aquatic exercise interventions


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PICO

Patient groupPatient 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


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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/10

6568753/CENTRALHelpFile.html#app

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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.

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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

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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’?

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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!

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When would you search theCochrane 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

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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"

“searching for all text schizo, drugs, atypical

and antipsychotic. in All Fields in The Cochrane

Database of Systematic Reviews"

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

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.

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.

Save or edit your search using

these links.

MeSH (Medical Subjects Heading Search)

Let us look at an example MeSH search

Let us look at an example MeSH search

Use the Thesaurus to search for MeSH descriptors

Use the Thesaurus to search for MeSH descriptors


Or use qualifiers.Or use qualifiers.


Search History

Select Search History to combine searches, enter their number together

with Boolean operator of choice (AND, OR, NOT).

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).

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. Your combined search will then appear in your Search History.

Search History

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15 minute Break!

Session 5: Small Group Work


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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

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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

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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

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Cochrane Library User Training Resources

http://www.cochrane.org/resources/clibtrain.htm

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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


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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


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Cochrane Library Tutorial

The Cochrane Library on Wiley InterScience User Guide Version 2.2

– http://www3.interscience.wiley.com/homepages/106568753/userguide.pdf

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Training Ideas

Fill out the back of your evaluation form

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The Cochrane Library Users’ Group

Offers:Answers from the expertsA forum for information-sharingAn opportunity for feedback

To get involved:www.CLUG.iwh.on.ca

Or contact Emma Irvin [email protected]

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Cochrane for Librarians

The Cochrane Information Retrieval Methods Group– http://www.irmg.cochrane.org/en/index.html

Have your say!


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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

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Questions?

Tamara Rader, MLISKnowledge Translation SpecialistCochrane Musculoskeletal [email protected]

Mary Ellen SchaafsmaCanadian Cochrane CentreInstitute of Population HealthPhone: (613) 562 5800 x5224Fax: (613) 562 5659Email: [email protected]: www.ccnc.cochrane.org

Thank you!

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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

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Double-blind,

placebo-controlled,

randomizedclinical trial

RandomizedControlled Trial

Controlled, Prospective Trial(eg. cohort trial)

Retrospective Trials(eg. case-control trial, case series)

Indirect Evidence, Anecdotes, Case Reports,Expert Opinion Consensus Committees

Levels of evidence, variable quality

Research users (consumers,health care professionals and policy makers) often poorly trained in critical appraisal skills

105

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.

106

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

What is a Randomized Controlled Trial (RCT)

The Cochrane Collaboration

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Centres13

Networks

Methods Groups

13

Fields16

Steering Group

Structure of The Cochrane Collaboration

Review Groups

52

109


Source: http://www.cochrane.org/resources/leaflet2of5structure.htm

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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

111

Cochrane Centres

112

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

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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 protected]

114

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

115

• 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

116

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

117

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 FieldHealth Equity Field

Cochrane Fields

Fields

118

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

119

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

Consumer Network

http://www.cochrane.org/consumers/homepage.htm

120120

Canadian Cochrane Network

121

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

122

Affiliate Organizations - sample

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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

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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.

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Title Registration

Find Cochrane Review Groups (CRGs) relevant to your topichttp://www.cochrane.org/contact/entities.htm#CRGLIST

Avoid overlap and duplication Registration form


Step 2: The Protocol

127

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


128

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!

129

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


130

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


131

Process

Cochrane Review Group (CRG) is involved for all steps

Review Manager (RevMan) softwarehttp://www.cc-ims.net/RevMan

Appraisal by editorial staff at CRG Protocol published in CDSR, then review

published in CDSR when completed


Step 3: Conducting the Review

133

Structure of a Full Cochrane Review

1. Plain-language summary2. Structured Abstract3. Background4. Objectives5. Selection Criteria6. Search strategy for

identification of studies 7. Methods of the review

8. Description of Studies9. Methodological quality of

included studies10. Results11. Discussion12. Author’s Conclusions13. Acknowledgements14. References

134

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

135

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.

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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


Step 4: Updating Your Review

138

Updating

Current recommendation – Every 2 years or when important new

evidence available

if less - risk being out of date and misleadingif 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


139Updates

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 registeredHenderson 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

140

Resources for conducting a Cochrane review

www.cochrane.org

141

Additional Cochrane Resources

Review production resources for authors & managing editorshttp://www.cochrane.org/resources/revpro.htm

Cochrane Handbook for Systematic Reviews of Interventionshttp://www.cochrane.org/resources/handbook/index.htm

Cochrane Collaborationopen learning material for reviewershttp://www.cochrane-net.org/openlearning/

Undertaking Systematic Reviews of Research on Effectivenesshttp://www.york.ac.uk/inst/crd/pdf/crdreport4_complete.pdf

RevMan homepage (Review Software)http://www.cc-ims.net/RevMan

142

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

144

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

145

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

147

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


148

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


149

The Well-defined Clinical Question

Population Intervention Comparator Outcomes Study Design

150

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.

151

Question Format

Among…,

does…,

compared to…,

result in…?


152

Review:

Name as many types of materials as you can that are found in The Cochrane Library

1. Protocols of systematic reviews

2. Systematic reviews

3. Health technology assessments

4. Randomized controlled trials


153

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: "asthma in Title, Abstract or Keywords in Cochrane Database of Systematic Reviews"


154

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]


155

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


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