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C A N C A C Training Day R A D E R 12 J A N08

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Information about C A N C A C Training Day R A D E R 12 J A N08

Published on January 10, 2008

Author: tamara.rader

Source: slideshare.net

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Cochrane Consumer Activities and Access to Medical Libraries Tamara Rader Cochrane Musculoskeletal Group January 12, 2008

What are we going to talk about today? Evidence-based health care Systematic reviews Cochrane Collaboration Access to information for all (NNLH) How consumers fit in

Evidence-based health care

Systematic reviews

Cochrane Collaboration

Access to information for all (NNLH)

How consumers fit in

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

Cohort studies

Case control studies

Cross sectional surveys

Case reports

Clinical trials

Randomized controlled trials

Reviews

Systematic reviews

Why don’t doctors use research results in practice? Lack of information management Individual studies may be misleading Need to put results into context

Lack of information management

Individual studies may be misleading

Need to put results into context

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

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

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

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? Reviews !

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

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

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

Systematic reviews are a way of synthesizing research evidence from many studies

Systematic reviews are a basic building block for planning future research

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

equal weight of studies High quality studies and weighted

General overview Focused question

What can systematic reviews tell us? Systematic reviews (including meta-analysis) generic method for addressing different questions – Epidemiological reviews of observational data Reviews of diagnostic test performance Reviews of effectiveness of interventions Reviews of efficiency of interventions Reviews of qualitative research Reviews of research methods Reviews of theories and models

Systematic reviews (including meta-analysis) generic method for addressing different questions –

Epidemiological reviews of observational data

Reviews of diagnostic test performance

Reviews of effectiveness of interventions

Reviews of efficiency of interventions

Reviews of qualitative research

Reviews of research methods

Reviews of theories and models

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

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

 

 

What is the Cochrane Collaboration? Cochrane Collaboration is a unique worldwide organization producing and disseminating systematic reviews on the effects of health care interventions

Cochrane Collaboration is a unique worldwide organization producing and disseminating systematic reviews on the effects of health care interventions

The Cochrane Collaboration is an international organisation that aims to help people make well­informed decisions about health care by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions. It is a not­for­profit organisation, established as a company, limited by guarantee, and registered as a charity in the UK . Mission Statement

The Cochrane Collaboration is an international organisation that aims to help people make well­informed decisions about health care by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions. It is a not­for­profit organisation, established as a company, limited by guarantee, and registered as a charity in the UK .

Cochrane Collaboration’s vision: Healthcare decision-making throughout the world will be informed by high quality, timely research evidence. The Cochrane Collaboration will play a pivotal role in the production and dissemination of this evidence across all areas of health care.

Healthcare decision-making throughout the world will be informed by high quality, timely research evidence.

The Cochrane Collaboration will play a pivotal role in the production and dissemination of this evidence across all areas of health care.

Organization of Cochrane International Steering Group - Governs the Cochrane Collaboration -Comprised of a group of elected representatives from the 5 types of Cochrane Groups (entities) Fields/Networks 13 Collaborative Review Groups (CRG) 50 Methods Groups (MG) 10 Centres 12

Writing Reviews Commenting on Reviews Editing Reviews Disseminating Reviews Searching for good studies Management

Who Does What? Collaborative Review Groups (CRG) - develop and maintain systematic reviews relevant to a particular health area - groups are coordinated by an editorial team who edit and assemble completed reviews into modules for inclusion in The Cochrane Library examples: Musculoskeletal, Effective Practice & Organization of Care, Back, Breast Cancer, Infectious Diseases, Tobacco Addiction Group

Collaborative Review Groups (CRG)

- develop and maintain systematic reviews relevant to a particular health area

- groups are coordinated by an editorial team who edit and assemble completed reviews into modules for inclusion in The Cochrane Library

examples: Musculoskeletal, Effective Practice & Organization of Care, Back, Breast Cancer, Infectious Diseases, Tobacco Addiction Group

 

6 review groups based in Canada Back Review Group- Toronto Effective Practice and Organisation of Care Review Group - Ottawa Hypertension Review Group - Vancouver Inflammatory Bowel Disease Review Group - London Musculoskeletal Review Group - Ottawa Neonatal Review Group - Hamilton

Back Review Group- Toronto

Effective Practice and Organisation of Care Review

Group - Ottawa

Hypertension Review Group - Vancouver

Inflammatory Bowel Disease Review Group - London

Musculoskeletal Review Group - Ottawa

Neonatal Review Group - Hamilton

Who Does What? Consumer Network - International network that facilitates the dissemination of information to patients, their families, friends and advocates Ensures consumer needs and interests are incorporated into the operation of the Collaboration Provides input to all activities of the Collaboration Helps set priorities for review topics Helps with translation of reviews

Consumer Network

- International network that facilitates the dissemination of information to patients, their families, friends and advocates

Ensures consumer needs and interests are incorporated into the operation of the Collaboration

Provides input to all activities of the Collaboration

Helps set priorities for review topics

Helps with translation of reviews

Affiliate Organizations Representatives from 20 healthcare professional organizations and consumer groups Purposes: Advise on future directions and activities Promote the awareness, appreciation, distribution and use of Cochrane systematic reviews among their members

Representatives from 20 healthcare professional organizations and consumer groups

Purposes:

Advise on future directions and activities

Promote the awareness, appreciation, distribution and use of Cochrane systematic reviews among their members

Affiliate Organizations L’Agence de é valuation des technologies et des modes d’intervention en sant é Arthritis Society Canadian Association of Occupational Therapists Canadian Association of Speech-Language, Pathologists and Audiologists Canadian Cancer Society Canadian Chiropractic Association Canadian Coordinating Office for Health Technology Assessment Canadian Dental Association Canadian Health Libraries Association Canadian Institute for Health Information Canadian Institute for the Relief of Pain and Disability

L’Agence de é valuation des technologies et des modes d’intervention en sant é

Arthritis Society

Canadian Association of Occupational Therapists

Canadian Association of Speech-Language, Pathologists and Audiologists

Canadian Cancer Society

Canadian Chiropractic Association

Canadian Coordinating Office for Health Technology Assessment

Canadian Dental Association

Canadian Health Libraries Association

Canadian Institute for Health Information

Canadian Institute for the Relief of Pain and Disability

Affiliate Organizations Canadian Medical Association Canadian Nurses Association Canadian Pharmacists Association Canadian Physiotherapy Association Canadian Task Force on Preventive Health Care Canadian Women’s Health Network College of Family Physicians of Canada Dietitians of Canada Institute for Clinical Evaluative Sciences Royal College of Physicians and Surgeons of Canada

Canadian Medical Association

Canadian Nurses Association

Canadian Pharmacists Association

Canadian Physiotherapy Association

Canadian Task Force on Preventive Health Care

Canadian Women’s Health Network

College of Family Physicians of Canada

Dietitians of Canada

Institute for Clinical Evaluative Sciences

Royal College of Physicians and Surgeons of Canada

People in Cochrane Over 10,000 involved internationally About 80 countries Mostly volunteers Diverse backgrounds, experience and expertise

Over 10,000 involved internationally

About 80 countries

Mostly volunteers

Diverse backgrounds, experience and expertise

People in Cochrane Epidemiologists/Statisticians Healthcare professionals Consumers Librarians

Epidemiologists/Statisticians

Healthcare professionals

Consumers

Librarians

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

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

Steps in Production Identify and prioritise topics to synthesise TITLE PROTOCOL REVIEW Plan how to synthesise 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, analyse and synthesise the studies Interpret results and determine impact of findings Write review Send review for comment Edit review Publish Cochrane review

Identify and prioritise topics

to synthesise

Plan how to synthesise 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, analyse and synthesise 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 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

evidence of value in identifying primary research topics

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

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

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

The Cochrane Library The main output of The Cochrane Collaboration, Cochrane Reviews, is contained in The Cochrane Database of Systematic Reviews , published electronically by John Wiley and Sons as part of The Cochrane Library .

The Cochrane Library All of the Cochrane systematic reviews are on the Internet In some countries such as the UK and Australia you can access it for free, Other countries you need to pay for a password to view them Most universities and some hospitals have the Library for their staff

All of the Cochrane systematic reviews are on the Internet

In some countries such as the UK and Australia you can access it for free,

Other countries you need to pay for a password to view them

Most universities and some hospitals have the Library for their staff

 

Where is the “evidence”? Health Journals Databases Web sites Libraries Government departments Professional associations Private companies

Health Journals

Databases

Web sites

Libraries

Government departments

Professional associations

Private companies

What’s wrong with that? Access to evidence is inequitable. Not all evidence is free Not all evidence is accessible to those who need it Not all evidence is easy to find Not easy to tell if evidence is valid

Access to evidence is inequitable.

Not all evidence is free

Not all evidence is accessible to those who need it

Not all evidence is easy to find

Not easy to tell if evidence is valid

 

National Network of Libraries for Health NNLH A network of existing health libraries and information services Will provide equal access to the best information for patient care Including databases, journals, books, reports, and web resources.

NNLH

A network of existing health libraries and information services

Will provide equal access to the best information for patient care

Including databases, journals, books, reports, and web resources.

Why the need for NNLH? Focus groups in 2001-2002 revealed gaps in access to information for health professionals. growing demand by health professionals for health information; the myth that either someone is taking care of making the literature accessible, or that &quot;it's all on the web&quot;.

Focus groups in 2001-2002 revealed gaps in access to information for health professionals.

growing demand by health professionals for health information;

the myth that either someone is taking care of making the literature accessible, or that &quot;it's all on the web&quot;.

High quality health care requires evidence-based decisions In the absence of a national network with equitable and coordinated access to information for health professionals…… Why a National Network?

High quality health care requires evidence-based decisions

In the absence of a national network with equitable and coordinated access to information for health professionals……

Many health care providers have little or no access to information resources and services Others have access from a variety of providers – in some cases with significant duplication Lack of access impacts significantly on health care practices and costs Simply providing access to resources without support does not adequately meet needs of front line care providers

Many health care providers have little or no access to information resources and services

Others have access from a variety of providers – in some cases with significant duplication

Lack of access impacts significantly on health care practices and costs

Simply providing access to resources without support does not adequately meet needs of front line care providers

How can NNLH help consumers? To inform their preferences and decisions To filter out unreliable information To make access to information more fair and equitable to all Canadian consumers

To inform their preferences and decisions

To filter out unreliable information

To make access to information more fair and equitable to all Canadian consumers

Where do consumers get information? Currently; TV and print media Individual doctor or health care professional Friends and family Public library or hospital library Internet websites of unknown quality

Currently;

TV and print media

Individual doctor or health care professional

Friends and family

Public library or hospital library

Internet websites of unknown quality

What’s wrong with that? Contradictory or inaccurate research results reported in the media Doctors, friends and family may or may not have current information Individual libraries have limited collections Web sites are of variable quality

Contradictory or inaccurate research results reported in the media

Doctors, friends and family may or may not have current information

Individual libraries have limited collections

Web sites are of variable quality

Canadian Health Network Providing health and lifestyle information in French and English since 1999. Collaboration of 26 major health organizations, universities, hospitals, and libraries. Was mandated with providing access to information to Canadian consumers.

Providing health and lifestyle information in French and English since 1999.

Collaboration of 26 major health organizations, universities, hospitals, and libraries.

Was mandated with providing access to information to Canadian consumers.

What’s the solution? Journalists being clear on the quality of the evidence Emphasizing results of systematic reviews over individual studies Access to high quality information to doctors and patients and family members alike Creating a network of libraries so consumers can benefit from the collection of all the libraries in the network

Journalists being clear on the quality of the evidence

Emphasizing results of systematic reviews over individual studies

Access to high quality information to doctors and patients and family members alike

Creating a network of libraries so consumers can benefit from the collection of all the libraries in the network

NNLH Vision The National Network of Libraries for Health (NNLH) will ensure that all health care providers in Canada will have equal access to the best information for patient care. It is designed to fit the Canadian health care model and fill in the information gaps inherent in a complex health delivery system.

The National Network of Libraries for Health (NNLH) will ensure that all health care providers in Canada will have equal access to the best information for patient care. It is designed to fit the Canadian health care model and fill in the information gaps inherent in a complex health delivery system.

Activities 2006-2007 Spring 2006 – CoO RFP Summer 2006 – CoO completed Thank-you: CISTI, PHAC, CAN, CMA February 2007 – NNLH Task Force meeting May 2007 – CMAJ letter June 2007 – development of VHL Phase 0 with Canada Health Infoways Fall 2007 – Canadian Health Network funding cancelled

Spring 2006 – CoO RFP

Summer 2006 – CoO completed

Thank-you: CISTI, PHAC, CAN, CMA

February 2007 – NNLH Task Force meeting

May 2007 – CMAJ letter

June 2007 – development of VHL Phase 0 with Canada Health Infoways

Fall 2007 – Canadian Health Network funding cancelled

Benefits of this model Coordinates and leverages the existing base of resources, services and expertise Builds on available infrastructure and develops opportunities for local and regional libraries to improve and expand unique services

Coordinates and leverages the existing base of resources, services and expertise

Builds on available infrastructure and develops opportunities for local and regional libraries to improve and expand unique services

Provides a virtual platform to facilitate knowledge transfer and exchange at a national level Preserves and provides access to key Canadian health care resources Effectively identifies and addresses service and resource gaps

Provides a virtual platform to facilitate knowledge transfer and exchange at a national level

Preserves and provides access to key Canadian health care resources

Effectively identifies and addresses service and resource gaps

Services Virtual Help Desk Training & Education Broader linkages (e.g. e-health records, patient safety, later linkages, emergency response, surveillance data, consumer health info, biotech sources, CHI)

Virtual Help Desk

Training & Education

Broader linkages (e.g. e-health records, patient safety, later linkages, emergency response, surveillance data, consumer health info, biotech sources, CHI)

Consumer Involvement Participating in research studies Advising on research priorities through Cochrane or other associations Commenting on Cochrane protocols and reviews Supporting the work of the National Network of Libraries of Health.

Participating in research studies

Advising on research priorities through Cochrane or other associations

Commenting on Cochrane protocols and reviews

Supporting the work of the National Network of Libraries of Health.

Thank you! Tamara Rader 613-562-5800 Ext. 2397 [email_address]

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