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

OUTLINE.......The HRB Fellowship award

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.......................

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.

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 conducting systematic reviews’.

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 group with people who have experience of conducting reviews in the fieldRegister a title with 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 reviewwhy it is important for you to do the review.

 

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......!!!)

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

Methods - Describe

types of studiestypes of participantstypes of interventionstypes 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).

Searching the databases........

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

Data Extraction….

Data Extraction sheets

Describe in detail for each study;

Participants

Interventions

Comparison groups

Outcome measures used

MethodsDetermine Risk of Bias

Random sequence generationAllocation concealmentBlinding of participantsBlinding of outcome assessorsIncomplete outcome dataSelective reporting

Rate the quality of the study in question

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.

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

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

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

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

From this....

To This....