Doing a Cochrane Systematic Review: Experience of one Speech and Language Therapist

1. Doing a Cochrane Systematic Review: Experience of one Speech and Language Therapist Zelda Greene MSc, Senior Speech and Language Therapist, Transitional Care Unit, Our Lady’s Children’s Hospital Crumlin

2. OUTLINE....... • The HRB Fellowshipaward • Training and education supports • Development of the review protocol • Systematic literature searching • Data screening and extraction process • Challenges! • Positive contribution that this experience has made to ongoing developments in the SLT department in OLCHC • The future.......................

3. Cochrane Collaboration • The Cochrane Collaboration is a not-for-profit and independent organisation dedicated to making up-to-date, accurate information about the effects of healthcare interventions readily available worldwide. • It produces and disseminates systematic reviews of healthcare interventions in over fifty topic areas and makes them available as The Cochrane Library (www.thecochranelibrary.com). • In 2002, Ireland became the first country in the world to provide free national access to the Cochrane Library, an initiative co-funded by the Health Research Board (HRB) and the Research and Development Office in Northern Ireland.

4. HRB CochraneFellowship Award • The aim of the Cochrane Fellowships Scheme is to build capacity in conducting systematic reviews in the health and social care field in Ireland by freeing up protected time for applicants to conduct a Cochrane systematic review in any topic of their choice. • Announced every March - Closing date end of May • ‘This scheme is open to individuals resident on the island of Ireland working in the health and social care area as health practitioners, researchers or policy makers’. • ‘As intensive and continuous training will be provided as part of the Fellowship, applications are invited from those with no prior experience or training in conductingsystematic reviews’.

5. What it involves....... • The Fellowship provides the Fellow with protected time of up to two days per week (14 hours) for up to two years to conduct their review. • The award covers systematic review training costs, salary-related costs and research expenses. • Application process - you must; • Form a local review groupwith people who have experience of conducting reviews in the field • Register a titlewith a Cochrane Review Group before you can apply for HRB grant (our group was based in Canada) • Apply via HRB website - • why it is important to do the review • why it is important for you to do the review.

6. Available Training and Support.......... Via HRB: Cochrane Training Courses • Build awareness and capacity in conducting systematic review in the island of Ireland.  • The HRB and the HSC Research & Development Division in Northern Ireland (HSC R&D Division), in association with the Training Team of the UK Cochrane Centre, offer two short courses on a number of dates annually. • Online training also via the UK Cochrane Group • Your Cochrane Review group editors (in our case Neonatal group) • Your co-authors (when you can find them!!!) • The Handbook (don’t read this first......!!!)

7. Developing the Protocol........... Provided with software ‘Revman’ - specifically for writing the protocol and the review • Background info (lit review) • Description of the condition • Description of the intervention • How the intervention might work • Why it is important to do this review • Primary & secondary objectives

8. Methods - Describe • types of studies • types of participants • types of interventions • types of outcome measures (primary and secondary) • Search methods for identification of studies (electronic/other; trial search coordinator) • Data collection and analysis (how are you going to select studies for inclusion/extract data and manage data).

9. Searching the databases........

10. Screen titles arising from search results in each database (we had 4,491 in total) • Identify titles where you get the abstracts for further screening (we had 81) • After screening these abstracts, finally identify eligible RCTs for all authors to extract data from independently (we identifed 24 RCTs) • You need to justify also why you EXCLUDE studies from your review

11. Data Extraction….

12. Data Extraction sheets Describe in detail for each study; • Participants • Interventions • Comparison groups • Outcome measures used

13. Methods • Determine Risk of Bias • Random sequence generation • Allocation concealment • Blinding of participants • Blinding of outcome assessors • Incomplete outcome data • Selective reporting • Rate the quality of the study in question

14. Data analysis...... • Heterogenous studies - Possible to make comparisons • Metanalysis then if possible • Revman will do the work once you put in the information. • Our studies we felt were not comparable and were of poor overall quality.

15. The Experience…….. • Very positive • Nice opportunity to get protected research time • Massive learning curve • Good training and support available • Very structured process • Software really helps with the flow of the project • Lovely opportunity to really delve deeply into the literature in one specific area in great detail • Approach literature very differently now - methodology is key: still don’t really understand statistics

16. Positives contd............ • Capable of extensive database searching • Minimum of 2 high impact publications at the end of the process • Other publications have arisen also • Have been asked to peer review 2 other studies for publication by other journals • Helps hone skills for designing good quality studies which is hopefully the next stage from here

17. Challenges...... • Isolation at times • Periods of great activity followed by no activity • Getting everyone on same task at same time • The Editorial teams can vary: initially good support, latterly less so when editor changed. Review groups vary. • Although it was cost neutral to OLCHC & I had a replacement for 2 years - I still was part of the department headcount. This affected recruitment of other staff for maternity cover etc during the duration of the grant: may affect future grant applications • HRB were tricky to deal with at times: paperwork

18. OLCHC SLT Department benefits: • Encouragement & support to colleagues • currently 7 active research projects underway • Using research resources available to us • Definitely present at local and national Meetings • Now aiming for International meetings also - 2 presentations at European feeding conference last year. • 2 Evidence based MDT clinical guidelines underway

19. From this.... To This....