Hilda BastianNN/LM Pacific Southwest Region, webinar10 April 2014

Systematic reviews and more @

Disclaimer

This talk and these slides represent the work and opinions of the presenter, and do not constitute official positions of the National Center for Biotechnology Information (NCBI), the US National Library of Medicine (NLM), the National Institutes of Health (NIH) or the US Department of Health and Human Services (HHS).

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In 1840,the entire collection could have been held by a four-shelf bookcase, shoulder high and 7 or 8 feet wide.

Figure: Bastian et al (see following)

Why we need systematic reviews:

There is a lot to know There are more than 75 trials a day & growing

Bastian H, Glasziou P, Chalmers I. 75 trials & 11 systematic reviews a day: how will we ever keep up? PLoS Medicine 2010 7(9):e1000326.

http://www.ncbi.nlm.nih.gov/pubmed/20877712

Conflicting information: the need for systematic reviews

Medical research is doubling every 7 years; the number of medical-related journals is doubling every 20 years*

Trials on a topic could be published in hundreds of journals* – not all in the same database – and in registries

Only sophisticated searching can reduce the risk of missing important evidence

* Hoffmann T, Erueti C, Thorning S, Glasziou P. The scatter of research: cross sectional comparison of randomised trials and systematic reviews across specialties. BMJ 2012; 344:e3223.

Why we need systematic reviews:

Research scatter

Systematic reviewing:

Search flowchart

* Horvath K, Koch K, Jeitler K, Matyas E, Bender R, Bastian H, Lange S, Siebenhofer A. Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. BMJ 2010; 340:c1395.

Searched:Embase, Medline, AMED, BIOSIS, CCMed, CDMS, CDSR, CENTRAL, CINAHL, DARE, HTA, NHS EED, Heclinet, SciSearch, several publishers’ databases, and reference lists of relevant secondary literature

Why we need systematic reviews:

Digesting data

Can’t juggle the results of multiple studies in different groups of people in your head reliably

Shortcuts are risky Usually not as simple as a head count:

3 positive + 1 negative positive

Cave: you often can’t combine data at all

What we mean by“systematic review”

Asks a structured, pre-specified question

Pre-specified, systematic methods for: - finding all potentially eligible studies - selecting which studies will be included - assessing quality of included evidence - synthesizing and interpreting results

Methods aim to minimize bias

May or may not include quantitative synthesis (meta-analysis)

Systematic reviews, CER, evidence-based…

PubMed Health concentrates on clinical effectiveness – but there are systematic reviews that answer other questions

CER can be “comparative effectiveness research” or “clinical effectiveness research”: may or may not be systematic reviews

Systematic reviews of systematic reviews: might be called overviews – might have both primary & secondary studies

“Rapid reviews”, “mini-reviews”, “evidence-based”

Guidelines, health technology assessments (HTA) and systematic reviews are not the same thing – except for the cases where they are!

Systematic reviews at NLM

Publication types “review” & “meta-analysis” but not “systematic review”

Hedged “Clinical Queries” filter for systematic reviews

PubMed Health, over 30,000 systematic reviews of health interventions from last 10 years via:

DARE – Database of Reviews of Effects Cochrane Database of Systematic Reviews

Curating health technology assessment (HTA) systematic reviews in partnership with HTA agencies

Links from PubMed tosystematic reviews via

“Knowledge translation”

Efforts aiming to make the results of systematic reviews accessible – to consumers, clinicians, policymakers

Critical appraisal: efforts aiming to sift out the most reliable systematic reviews

From AHRQ Effective Health Care Program:

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PubMed Health

Aims to:Help people find systematic reviewsUnderstand what they find

How:Gathering systematic reviews, knowledge translation & educational materials for the public & clinicians

Background articles – NLM Technical Bulletin:

http://www.nlm.nih.gov/pubs/techbull/so11/so11_pm_health.html

http://www.nlm.nih.gov/pubs/techbull/nd11/nd11_pm_health.html

Facets - primary “CER” search - Encyclopedia

- Clinical Queries

Tips for systematic reviews & PubMed Health

First topic pages - drugs

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011495/

First new topic pages – drugs

Just started – Health A-Z

Just started – Health A-Z:With anatomy, tests, symptoms, definitions…

Just started – Health A-Z:Will develop into a site-wide glossary

Helping peopleunderstand

Knowledge translation materials & medical encyclopedia

Section on “Understand Clinical Effectiveness” – includes educational articles & full text bookshttp://www.ncbi.nlm.nih.gov/pubmedhealth/understanding-research-results/

“Behind the Headlines”: critical appraisal of studies reported in the

news http://www.ncbi.nlm.nih.gov/pubmedhealth/behindtheheadlines/

Tweets / Google+ / Facebook on clinical effectiveness concepts

Thanks!

http://www.pubmed.gov/health

Twitter: @PubMedHealth

https://www.facebook.com/PubMedHealth

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