hilda bastian scr connections webinar 17 july 2013 systematic reviews and more @
TRANSCRIPT
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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Figure: Bastian et al (see following)
In 1840,the entire collection could have been held by a four-shelf bookcase, shoulder high and 7 or 8 feet wide.
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
Why we need systematic reviews:Research scatter
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.
Systematic reviewing:
Search flowchartSearched: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
* 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.
Why we need systematic reviews:
Digesting data
Cave: you often can’t combine data at all
Can’t juggle the results of multiple studies in different groups of people in your head reliable
Shortcuts are risky Usually not as simple as a head count:
3 positive + 1 negative positive
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!
“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:
PubMed Health
Aims to:Help people find systematic reviewsUnderstand what they find
How:Gathering systematic reviews, knowledge translation & educational materials
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
Finding (good) systematic reviews
Found & critically appraised in DARE (Database of Reviews of Effects)
Cochrane Database of Systematic Reviews (Cochrane Library)
Unselected: INAHTA database (with DARE)
Selected: @ PubMed Health
* All 3 types @
PubMed Health
Aim: a comprehensive clinical effectiveness review search Cochrane reviews + DARE* reviews + systematic reviews
by health technology assessment agencies
Now around 26,000 systematic reviews from the last 10 years
Simultaneous search of PubMed with “Clinical Queries” systematic review filter
http://www.ncbi.nlm.nih.gov/pubmedhealth/aboutcer/
* Database of Reviews of Effects
First new topic pages - drugs
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011495/
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
PubMed Healthpartners include:
NHS Centre for Reviews & Dissemination (producers of DARE)
Cochrane Collaboration
Health technology assessment agencies, including AHRQ (Agency for Healthcare Research & Quality)
Producers of knowledge translation materials, including National Cancer Institute (NCI)
Thanks!
http://www.pubmed.gov/health
Twitter: @PubMedHealth
https://www.facebook.com/PubMedHealth
Google+
1 Hour MLA CE
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