How to comment on a Cochrane review

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Information about How to comment on a Cochrane review

Published on March 19, 2008

Author: tamara.rader

Source: slideshare.net

Providing the Consumer Perspective: How to comment on Cochrane reviews and protocols Tamara Rader Cochrane Musculoskeletal Group March 6, 2008

Welcome! Introductions Any questions?

Introductions

Any questions?

Outline of workshop Background The production of Cochrane reviews Group work: Corticosteroid injection for trigger finger in adults. Common concerns of consumers Anything else?

Background

The production of Cochrane reviews

Group work: Corticosteroid injection for trigger finger in adults.

Common concerns of consumers

Anything else?

The importance of your input consumers have expertise in the experience of the illness they offer unique suggestions “from a strong knowledge base (often based on their personal experience and that of other health service users)” consumers bring a new perspective and a fresh set of eyes

consumers have expertise in the experience of the illness

they offer unique suggestions “from a strong knowledge base (often based on their personal experience and that of other health service users)”

consumers bring a new perspective and a fresh set of eyes

Evidence of the value of consumer input 2006 Cochrane review looked at methods of consumer involvement that found: Involving consumers to develop patient information improves its clarity and relevance; telephone calls and face-to-face meetings may engage consumers more and change priority setting than mailed surveys

2006 Cochrane review looked at methods of consumer involvement that found:

Involving consumers to develop patient information improves its clarity and relevance;

telephone calls and face-to-face meetings may engage consumers more and change priority setting than mailed surveys

Why we like consumer opinions: Add value to the protocols and reviews Help us save time by identifying priorities Ultimately make the review more meaningful and relevant Consumer opinions help fulfill one of the requirements of evidence-based health care

Add value to the protocols and reviews

Help us save time by identifying priorities

Ultimately make the review more meaningful and relevant

Consumer opinions help fulfill one of the requirements of evidence-based health care

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

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

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

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

 

 

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

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

The production of Cochrane reviews Register the title Write the protocol Write the review Update every 2 years

Register the title

Write the protocol

Write the review

Update every 2 years

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

Identify and prioritize topics

to synthesize

Plan how to synthesize 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, analyze and synthesize 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, avoid duplication 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, avoid duplication

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

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

Common consumer concerns: “What is the difference between the abstract and synopses?” The Synopses is aimed at consumers and the Abstract is aimed at practitioners and policy makers Synopses is in plain language Both follow a structured format

“What is the difference between the abstract and synopses?”

The Synopses is aimed at consumers and the Abstract is aimed at practitioners and policy makers

Synopses is in plain language

Both follow a structured format

Consumer concerns continued… “This writing is unclear and I noticed some mistakes.” Authors come from around the world, English may not be their first language. Don’t worry about typos or grammar, reviews get copy-edited.

“This writing is unclear and I noticed some mistakes.”

Authors come from around the world, English may not be their first language.

Don’t worry about typos or grammar, reviews get copy-edited.

Consumer concerns continued… “This treatment is not available to me.” Cochrane have world-wide coverage of treatments and some might be more common in other places. Probably worthwhile to note the reason the treatment is not available: for example, not covered by insurance, too expensive, not part of normal care.

“This treatment is not available to me.”

Cochrane have world-wide coverage of treatments and some might be more common in other places.

Probably worthwhile to note the reason the treatment is not available: for example, not covered by insurance, too expensive, not part of normal care.

Consumer concerns continued… “Do I have to print all of it?” 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.

“Do I have to print all of it?”

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.

Consumer concerns continued… “I don’t understand this condition/intervention/statistic” We try to give you reviews on topics you have experience or interest in Review groups can offer help It’s always fine to write that you don’t understand something, but even better if you can say why.

“I don’t understand this condition/intervention/statistic”

We try to give you reviews on topics you have experience or interest in

Review groups can offer help

It’s always fine to write that you don’t understand something, but even better if you can say why.

Consumer concerns continued… “Can I have some feedback on my comments?” Feedback usually comes from the editor We try to send the review to the consumer who did the protocol As in peer review, authors must address each comment from the consumer

“Can I have some feedback on my comments?”

Feedback usually comes from the editor

We try to send the review to the consumer who did the protocol

As in peer review, authors must address each comment from the consumer

Consumer concerns continued… “I’m not feeling well, and I can’t comment in the near future” Other ways to become involved A larger pool of consumer reviews means that no one feels over burdened

“I’m not feeling well, and I can’t comment in the near future”

Other ways to become involved

A larger pool of consumer reviews means that no one feels over burdened

Other tips: Be specific in your comments Be practical, if you feel a major outcome is missing, suggest that it be added when the review is updated Be constructive in your criticism.

Be specific in your comments

Be practical, if you feel a major outcome is missing, suggest that it be added when the review is updated

Be constructive in your criticism.

Collaborative, not adversarial. Editors, authors, and consumers are all working toward the same goal.

Editors, authors, and consumers are all working toward the same goal.

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

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