1 / 23

FACET - European Journal of Cancer Care September 2003

FACET - European Journal of Cancer Care September 2003. Systematic Reviews and the Cochrane Collaboration MUNRO, A.J. 1. Systematic Reviews and the Cochrane Collaboration. Who was Archie Cochrane, and why do we collaborate in his name?

gavin
Download Presentation

FACET - European Journal of Cancer Care September 2003

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration MUNRO, A.J.1 Systematic Reviews and the Cochrane Collaboration Who was Archie Cochrane, and why do we collaborate in his name? He was a public health physician whose ideas were ahead of their time: he was sceptical about the assumption that doctors always knew best; he thought that clinicians should justify their decisions, rather than simply be allowed to do whatever they felt like. Slide One *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  2. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) Archie Cochrane Slide Two *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  3. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) The main problem identified by Cochrane “Inflation”: input rising much faster than output, costs of health care rising faster than any demonstrable improvements in health. Care and cure contrasted: the opportunity cost of inflation in ‘cure’ sector is sub-standard services in the ‘care’ sector. Solution: Make cure lean and efficient and there will be nourishment for care. Slide Three *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  4. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) • The agenda set by Cochrane for assessing an intervention • Effectiveness • Does it work? • Efficiency • Is it good value for money? • Evaluation • Has it been properly tested? • Equality • Can it be made available for everyone? Slide Four *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  5. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) • Evidence: problems of assembly and assimilation • Overload • There are around 23,000 journals publishing 2,000,000 papers in biology and medicine each year. • These are published in a variety of languages and types of journals. • To keep up with the ten leading medical journals requires looking at 200 papers and 70 editorials per month - each paper takes 30 to 60 minutes to read in detail. • The paper mountain • The biomedical literature produces a stack of papers growing at a rate of 2 km per year. • 4 years’ worth is the height of Mount Everest. Slide Five *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  6. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) • The nine values • Collaboration • Building on the enthusiasm of individuals • Avoiding duplication • Minimizing bias • Keeping up to date • Ensuring relevance • Ensuring access • Continually improving the quality of its work • Continuity Slide Six *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  7. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) • Components of the collaboration (1) • Steering Group • Collaborative review groups (CRGs) Slide Seven *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  8. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) • Components of the collaboration (2) • Cochrane Centres • Fields & Networks Slide Eight *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  9. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) • Components of the collaboration (3) • Methods groups • Consumer network Slide Nine *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  10. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) • What is the Cochrane Product? • The Cochrane Library • Database of systematic reviews • Reviews (1669) • Protocols (1266) • Register of controlled clinical trials (362,540) • Database of abstracts of reviews of effectiveness (DARE) (4006) • Health technology assessment database (3138) • Cochrane methodology register (4553) • Database of methodology reviews (16) • NHS economic evaluation database (11,485) Slide Ten *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  11. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) A Systematic Review Slide Eleven *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  12. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) • How reliable? • 1998 quality review • 15/53 reviews had major defects • 9/53 evidence did not support conclusions • 12/53 conduct or reporting unsatisfactory • 12/53 problems with style Slide Twelve *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  13. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) • Problems (1) • Difficult to grasp the structure and vocabulary • Recruitment and retention • Costs and charging for library • Consumer involvement • Perceived Stalinism Slide Thirteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  14. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) • Problems (2) • Publication/citation • The mythical Albanian trial and the law of diminishing returns • How do you assess evidence concerning interventions for which RCT is inappropriate or impossible (e.g. rare tumours)? • Old trials test obsolete techniques Slide Fourteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  15. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) “Artze sind Überflussig” (doctors are superfluous) Slide Fifteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  16. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) Cochrane Collaboration – the real product Slide Sixteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  17. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) Web based resources Much of the text used in this presentation has been adapted from the information available on the Cochrane Collaboration website. • http://www.cochrane.org/ • The Cochrane manual provides considerable detail about the organisation and methods of the collaboration: it can be downloaded from: http://www.cochrane.org/cochrane/cc-man.htm • The Cochrane library can be found at: http://www.update-software.com/cochrane/ (access via this portal is limited, unless you or your institution have a password or gateway) • If you are using a computer recognised as belonging to the UK NHS network you can access the full Cochrane library via: http://www.nelh.nhs.uk/cochrane.asp • The Cochrane Reviewer’s handbook can be downloaded from: http://www.cochrane.org/cochrane/hbook • The Cochrane Cancer Network website is at: http://www.canet.org/ Slide Seventeen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  18. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) Other sources of information • Altman, D.G. (2001). Systematic reviews of evaluations of prognostic variables. Bmj (Clinical Research Ed.), 323: 224-8. • Antman, E.M., Lau, J., Kupelnick, B. et al (1992). A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. Journal of the American Medical Association. 268: 240-8. • Clarke, M. (2002). Commentary: searching for trials for systematic reviews: what difference does it make?International Journal of Epidemiology. 31: 123-4. • Cochrane, A.L. (1989). Effectiveness and Efficiency: random reflections on health services. The Rock Carling Fellowship 1971. BMJ Books. London. • Cochrane, A.L. & Blythe, M. (1989). One Man's Medicine: An Autobiography of Professor Archie Cochrane. BMJ Books. London. Slide Eighteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  19. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) Other sources of information (continued) • Deeks, J.J. (2001). Systematic reviews in health care: Systematic reviews of evaluations of diagnostic and screening tests. Bmj (Clinical Research Ed.). 323: 157-62. • Dickersin, K. & Manheimer, E. (1998). The Cochrane Collaboration: evaluation of health care and services using systematic reviews of the results of randomized controlled trials. Clinical Obstetrics and Gynecology, 41: 315-31. • Dixon-Woods, M., Fitzpatrick, R. & Roberts, K. (2001). Including qualitative research in systematic reviews: opportunities and problems. Journal of Evaluation in Clinical Practice. 7: 125-33. • Easterbrook, P.J., Berlin, J.A., Gopalan, R. et al. (1991). Publication bias in clinical research. Lancet. 337: 867-72. • Egger, M., Davey Smith, G. & Altman, D.G. (2001). Systematic Reviews in Health Care: meta-analysis in context. BMJ Books. London. Slide Nineteen *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  20. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) Other sources of information (continued) • Egger, M., Juni, P., Bartlett, C. et al (2003). How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technology Assessment (Winchester, England). 7: 1-76. • Egger, M., Zellweger-Zahner, T., Schneider, M. et al (1997). Language bias in randomised controlled trials published in English and German. Lancet. 350: 326-9. • Evans, D. & Pearson, A. (2001). Systematic reviews: gatekeepers of nursing knowledge. Journal of Clinical Nursing. 10: 593-9. • Grimshaw, J.M., Shirran, L., Thomas, R., et al (2001). Changing provider behavior: an overview of systematic reviews of interventions. Medical Care. 39; II2-45. • Juni, P., Altman, D.G. & Egger, M. (2001). Systematic reviews in health care: Assessing the quality of controlled clinical trials. Bmj (Clinical Research Ed.). 323: 42-6. Slide Twenty *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  21. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) Other sources of information (continued) • Juni, P., Holenstein, F., Sterne, J. et al. (2002). Direction and impact of language bias in meta-analyses of controlled trials: empirical study. International Journal of Epidemiology. 31: 115-23. • Klassen, T.P., Wiebe, N., Russell, K. et al. (2002). Abstracts of randomized controlled trials presented at the society for pediatric research meeting: an example of publication bias. Archives of Pediatrics & Adolescent Medicine. 156: 474-9. • Linde, K. & Willich, S.N. (2003). How objective are systematic reviews? Differences between reviews on complementary medicine. Journal of the Royal Society of Medicine. 96: 17-22. • Macbeth, F. & Overgaard, J. (2002). Expert reviews, systematic reviews and meta-analyses. Radiotherapy and Oncology : Journal of the European Society For Therapeutic Radiology and Oncology. 64: 233-4. Slide Twenty One *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  22. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) Other sources of information (continued) • Moher, D. & Schachter, H.M. (2002). Potential solutions to the problem of conducting systematic reviews of new health technologies. Canadian Medical Association Journal 166: 1674-5. • Olsen, O., Middleton, P., Ezzo, J., Gotzsche, P.C., Hadhazy, V., Herxheimer, A., Kleijnen, J. & McIntosh, H. (2001). Quality of Cochrane reviews: assessment of sample from 1998. Bmj (Clinical Research Ed.). 323: 829-32. • Petticrew, M. (2001). Systematic reviews from astronomy to zoology: myths and misconceptions. Bmj (Clinical Research Ed.). 322: 98-101. • Rothwell, P.M. (2002). Why do clinicians sometimes find it difficult to use the results of systematic reviews in routine clinical practice? Evaluation and the Health Professions. 25: 200-9. Slide Twenty Two *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

  23. FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration(continued) Other sources of information (continued) • Shea, B., Moher, D., Graham, I. Et al. (2002). A comparison of the quality of Cochrane reviews and systematic reviews published in paper-based journals. Evaluation and the Health Professions. 25: 116-29. • Silagy, C.A., Middleton, P. & Hopewell, S. (2002). Publishing protocols of systematic reviews: comparing what was done to what was planned. Journal of the American Medical Association. 287: 2831-4. • Sterne, J.A., Egger, M. & Smith, G.D. (2001). Systematic reviews in health care: Investigating and dealing with publication and other biases in meta-analysis. Bmj (Clinical Research Ed.). 323: 101-5. • Sutton, A.J., Duval, S.J., Tweedie, R.L. et al (2000). Empirical assessment of effect of publication bias on meta-analyses. Bmj (Clinical Research Ed.). 320: 1574-7. Slide Twenty Three *Click on “View”; “Notes Page” for explanatory notes slides available at: www.blackwellpublishing.com/journals/ecc

More Related