Systematic Reviews in healthcare and the Joanna Briggs Institute /Cochrane Collaboration. Fiona Bath-Hextall

Transcription

1 Systematic Reviews in healthcare and the Joanna Briggs Institute /Cochrane Collaboration Fiona Bath-Hextall

2 Remit The importance of Systematic Reviews Who uses systematic reviews? Where can we find them? Quality of systematic reviews JBI Collaboration Cochrane Collaboration JBI/Cochrane relationship A bit about our Centre of Evidence Based Healthcare: a Collaborating Centre of the Joanna Briggs Institute

3 Nottingham

4 Nottingham Lace

5 Nottingham castle and caves

6 Ye Old Trip To Jerusalem

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9 Nottingham Forest

10 Aerial image of University Park Campus

11 Trent building

12 Malaysia Campus

13 Ningbo Campus

14 Evidence Based Cycle

15 Evidence-Based Practice Evidence-Based Practice (EBP) is a problem-solving approach to the delivery of care that incorporates the best evidence from well-designed studies in combination with a clinician s expertise and patients preferences within a context of caring Sackett et al 2000

16 Needs and preferences of patients and clients Evidence-based health care The best available evidence The professional s expertise, skills and judgement

17 Key milestones in EBP 1972 Archi Cochrane - monograph 1977 Canadian survey doctors failing to keep up to date with current research 1980 s Archi Cochrane s ideas taken up by Ian Chalmers who begins reviewing care during pregnancy and childbirth 1987 Archi Cochrane refers to Ian Chalmers review as a milestone in the history of randomised controlled trials and in the evaluation of care

18 1988 The Cochrane Collaboration formed 1992 EBM in the literature, other disciplines follow suit NHS Centre for Reviews and Dissemination (CRD) is established in the UK The Joanna Briggs Institute (JBI ) in Australia is founded The Campbell Collaboration is established in the USA

19 Systematic Reviews A systematic review attempts to collate all empirical evidence that fits pre-specified eligibility criteria in order to answer a specific research question. It uses explicit, systematic methods that are selected with a view to minimizing bias, thus providing more reliable findings from which conclusions can be drawn and decisions made Oxman 1993

20 Differences between Literature reviews and systematic reviews Literature review Systematic review (conducted according to an explicit methodology and are reproducible) Framing the question Often a broad question Well structured question Identifying relevant literature Not usually specified, often not reproducible Clear and reproducible search strategy Assessing the quality of the literature Variable Rigorous critical appraisal Summarising the evidence Often a qualitative summary May be qualitative or quantitative depending on the question * Interpreting and exploring clinical relevance of findings May be biased Usually evidence-based

21 Quality of Systematic Reviews PRISMA Guidelines Preferred Reporting Items for Systematic Reviews and Meta-Analyses. It is an evidence-based minimum set of items for reporting in systematic reviews and metaanalyses.

22 Types of Systematic Reviews Quantitative Qualitative Mixed methods Umbrella Reviews or Reviews of Reviews or Overview of Reviews Multiple treatment meta-analysis new emerging methodology

23 The need for systematic reviews Healthcare providers Consumers Researchers Policy makers

24 Informing Guidelines Systematic Review Guideline BAD guidelines on the treatment of BCC and other European Guidelines Interventions for Basal cell carcinoma of the skin NICE Guidelines: Improving the outcomes for people with skin tumours including melanoma Royal College of Optometrists guideline on BCC of eyelid Interventions for non-metastatic squamous cell carcinoma of the skin Probiotics for treating eczema Interventions to reduce Staphylococcus aureus in the management of atopic eczema BAD Guidelines -Interventions for SCC SIGN Guidelines 2014 Scottish Intercollegiate Guidelines Network (SIGN). Management of atopic eczema in primary care. Edinburgh: SIGN;2011 (SIGN pub No 125) Scottish Intercollegiate Guidelines Network (SIGN). Management of atopic eczema in primary care. Edinburgh: SIGN;2011 (SIGN pub No 125)

25 Informing Primary Research Systematic review Subsequent Research project Funded by Interventions to reduce Staphylococcus aureus in the management of atopic eczema RCT HTA Interventions for Basal cell carcinoma of the skin An RCT of excisional surgery versus imiquimod 5% cream for nodular and superficial basal cell carcinoma Cancer Research UK Interventions for non-metastatic squamous cell carcinoma of the skin two reviews First - RCTs Second -observational studies SCC feasibility work to inform RCT Protocol for RCT now designed NIHR programme grant ( finished) Dietary exclusions for improving established atopic eczema in adults and children Eczema is being used to develop a work stream as part of the NIHR programme grant NIHR programme grant ( finished)

26 Changing Practice Systematic Review P Antibiotics for the prophylaxis of bacterial endocarditis in dentistry Practice Reduction in number of people taking antibiotics before invasive dental procedures Evidence based recommendations for screening for oral SCC Oral SCC picked up earlier Episiotomy for vaginal birth Reduced international episiotomy rates Position for women during second stage of labour Increased the use of upright positions for birth Interventions for the prevention of falls in the community Reduction in number of falls

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28 The Cochrane Collaboration Our vision is that healthcare decision-making throughout the world will be informed by highquality, timely research evidence Gold standard, IF (5.715)

29 International non-profit, independent organisation Network > 28,000 dedicated people from over 100 countries. Registered charity in the United Kingdom central functions are funded by royalties from its publishers, John Wiley and Sons Limited (sales of subscriptions to The Cochrane Library) Individual entities are funded by a large variety of governmental, institutional and private funding sources

30 Professor Archibald Leman Cochrane, CBE FRCP FFCM, ( ) source: Cardiff University Library, Cochrane Archive, University Hospital Llandough.

31 The Cochrane Library Available by subscription, on the Internet and CD- ROM Many countries have a national subscription to The Cochrane Library - Allows free access to the Library Abstracts of Reviews freely available The Cochrane Library contains a number of additional databases

32 Cochrane Library

33 Search

34 Webliography of resources for EBHC

35 EBP Tools

36 Cochrane Clinical Answers

37 Cochrane Clinical Answers Content Coverage

38 The Cochrane Collaboration Review Groups Centres Steering Group Consumer Network Methods Groups

39 Review Groups Review group focus on particular areas of health e.g. Breast cancer, infectious Diseases, Multiple Sclerosis, Schizophrenia, stroke, skin Groups - people who prepare, maintain and update Cochrane Reviews, and people who support them in this process. Each Group has an 'editorial base'

40 Centres Support people in their geographic and linguistic area. provide training help with translations Networking If you are new contact your local Cochrane Centre for information - can save a lot of time and effort

41 Methods Groups People who develop the methodology of Cochrane Reviews Consumer Network Provides information and a forum for networking among consumers

42 Cochrane Collaboration Review Groups Centres Steering Group Consumer Network Methods Groups

43 Help with Preparing a Cochrane Review. Open Learning Material Cochrane Handbook for Systematic Reviews of Interventions Cochrane Centres and some Cochrane Review Groups provide or facilitate training through workshops

44 How to get started Decide on title Contact Cochrane Review Group Check for overlap with existing review or protocols Complete the title registration Protocol Full review Publish in Cochrane Library Remember that the lead reviewer will be expected to update the review Publish in another journal

45 RevMan (Review Manager)

46 RevMan

47 Handbook

48 The Joanna Briggs Institute International collaboration of health scientists, health professionals and health researchers To improve global health through providing pointof-care access to: Evidence databases Decision support systems Implementation, evaluation and continuous improvement tools

49 The Joanna Briggs Institute Evidence Based Practice Research Institute since 1996 Royal Adelaide Hospital and the University of Adelaide Not-for-profit 70+ Centres and Groups, >7000 members in over 47 countries Global Leader

50 The Joanna Briggs Institute

51 Home of: Process and Implementation sub group

52 JBI Vision Evidence-informed Best Practice as a central characteristic of all health services.

53 JBI Mission To be the leader in producing, disseminating and providing a framework for the use of the best available research evidence to inform health decision-making to improve health outcomes globally.

54 The JBI Model of Evidence-based Healthcare

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61 The Joanna Briggs Institute

62 Programs

63 Centers

64 Networks

65 Members

66 JBI Webpage

67 Page shot JBI Library

68 JBI library search

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71 PACES User friendly on-line tool to make audit, feedback and practice improvement easier to implement and report Facilitates data collection and entry GRIP: assists in the development of a plan for practice improvement

72 Submit the RAP for peer review If the RAP is deemed to be suitable it will be published in the RAP Library

73 Doing a review Submit title of review Protocol within 6 months editors /peer review Full review

74 The JBI Software System for the Unified Management, Assessment and Review of Information

75 Consists of the following components Comprehensive Review and Management System Keeps all review information together and generates a report that may contain elements from all other SUMARI modules

76 Protocol Reviewers Search strategy Bibliography - retrieved studies Bibliography - non selected studies

77 Qualitative Assessment and Review Instrument

78 Narrative Opinion and Text Assessment and Review Instrument

79 Meta-Analysis of Statistics Assessment and Review Instrument (Used in place of Review Manager for non-cochrane reviews)

80 Analysis of Cost Technology and Utilisation Assessment and Review Instrument

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82 CReMS

83 Reviews Summary JBI/Cochrane Cochrane Quantitative (mostly looking at RCTs) Qualitative (one quants/quals) Umbrella Reviews JBI Quantitative ( all types of evidence) Qualitative Mixed Methods Umbrella Reviews Reviews done through: Review Groups JBI Synthesis Group Handbook yes Yes Library The Cochrane Library Cochrane Reviews Other reviews Trials Methods Studies Technology Assessments Economic Evaluations The JBI Library of Systematic Reviews JBI COnNECT+ Systematic Reviews (full/protocols) Best practice info sheets Evidence summaries Consumer information sheets Evidence Based RecommendPractices Quality tools Methodological quality tools Methodological quality Software RevMan CReMS GRADEPro DASR - additional software Other EBP tools Directed to other tools RAPid TAP PACES Levels of Evidence and Strength of evidence GRADE Manual builder GRADE Adapted for qualitative reviews

84 University of Nottingham Centre of Evidence Based Healthcare: a Collaborating Centre of the Joanna Briggs Institute

85 Centre Webpage

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87 Question Drop