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Systematic reviews and knowledge translation
Tugwell,Peter; Robinson,Vivian; Grimshaw,Jeremy; Santesso,Nancy;
Bulletin of the World Health Organization , 2006, DOI: 10.1590/S0042-96862006000800016
Abstract: proven effective interventions exist that would enable all countries to meet the millennium development goals. however, uptake and use of these interventions in the poorest populations is at least 50% less than in the richest populations within each country. also, we have recently shown that community effectiveness of interventions is lower for the poorest populations due to a "staircase" effect of lower coverage/access, worse diagnostic accuracy, less provider compliance and less consumer adherence. we propose an evidence-based framework for equity-oriented knowledge translation to enhance community effectiveness and health equity. this framework is represented as a cascade of steps to assess and prioritize barriers and thus choose effective knowledge translation interventions that are tailored for relevant audiences (public, patient, practitioner, policy-maker, press and private sector), as well as the evaluation, monitoring and sharing of these strategies. we have used two examples of effective interventions (insecticide-treated bednets to prevent malaria and childhood immunization) to illustrate how this framework can provide a systematic method for decision-makers to ensure the application of evidence-based knowledge in disadvantaged populations. future work to empirically validate and evaluate the usefulness of this framework is needed. we invite researchers and implementers to use the cascade for equity-oriented knowledge translation as a guide when planning implementation strategies for proven effective interventions. we also encourage policy-makers and health-care managers to use this framework when deciding how effective interventions can be implemented in their own settings.
Systematic reviews and knowledge translation  [cached]
Tugwell Peter,Robinson Vivian,Grimshaw Jeremy,Santesso Nancy
Bulletin of the World Health Organization , 2006,
Abstract: Proven effective interventions exist that would enable all countries to meet the Millennium Development Goals. However, uptake and use of these interventions in the poorest populations is at least 50% less than in the richest populations within each country. Also, we have recently shown that community effectiveness of interventions is lower for the poorest populations due to a "staircase" effect of lower coverage/access, worse diagnostic accuracy, less provider compliance and less consumer adherence. We propose an evidence-based framework for equity-oriented knowledge translation to enhance community effectiveness and health equity. This framework is represented as a cascade of steps to assess and prioritize barriers and thus choose effective knowledge translation interventions that are tailored for relevant audiences (public, patient, practitioner, policy-maker, press and private sector), as well as the evaluation, monitoring and sharing of these strategies. We have used two examples of effective interventions (insecticide-treated bednets to prevent malaria and childhood immunization) to illustrate how this framework can provide a systematic method for decision-makers to ensure the application of evidence-based knowledge in disadvantaged populations. Future work to empirically validate and evaluate the usefulness of this framework is needed. We invite researchers and implementers to use the cascade for equity-oriented knowledge translation as a guide when planning implementation strategies for proven effective interventions. We also encourage policy-makers and health-care managers to use this framework when deciding how effective interventions can be implemented in their own settings.
The landscape of knowledge translation interventions in cancer control: What do we know and where to next? A review of systematic reviews
Melissa C Brouwers, Kimberly Garcia, Julie Makarski, Lubna Daraz, of the Evidence Expert Panel, of the KT for Cancer Control in Canada Project Research Team
Implementation Science , 2011, DOI: 10.1186/1748-5908-6-130
Abstract: Using three databases, we conducted a search and identified English-language systematic reviews published between 2005 and 2010 that targeted consumer, professional, organizational, regulatory, or financial interventions, tested exclusively or partially in a cancer context (primary focus); generic or non-cancer-specific reviews were also considered. Data were extracted, appraised, and analyzed by members of the research team, and research ideas to advance the field were proposed.Thirty-four systematic reviews providing 41 summaries of evidence on 19 unique interventions comprised the evidence base. AMSTAR quality ratings ranged between 2 and 10. Team members rated most of the interventions as promising and in need of further research, and 64 research ideas were identified.While many interventions show promise of effectiveness in the cancer-control context, few reviews were able to conclude definitively in favor of or against a specific intervention. We discuss the complexity of implementation research and offer suggestions to advance the science in this area.Innovations in screening and early detection, development of effective treatment interventions, and strategies to improve quality of life have emerged from primary studies, and systematic reviews of these studies, in cancer control [1-9]. These advancements have the capacity to reduce mortality and morbidity from disease. However, optimizing these advancements requires their appropriate application, a goal that is often difficult to achieve [10,11]. Understanding what are the most effective and promising interventions is warranted to ensure that the appropriate options are chosen and incorporated into implementation plans and prioritized for future research studies. The analysis of studies examining the effectiveness of implementation interventions is a key component to an overall knowledge translation (KT) research agenda [12].The purpose of our study was to conduct a review of systematic reviews to better unde
Systematic reviews (I)
Miguel Araujo Alonso
Medwave , 2011,
Abstract: Systematic reviews are the best way to bring together and synthesize scientific evidence on a subject by applying a method that ensures minimization of bias and study shortcomings. This was mentioned in a previous article of this series. This goal can be achieved by recurring to the principles of the scientific method. The research subjects are not patients but published clinical trials and other sources from which data are extracted. In the beginning, these studies were limited to therapeutic effectiveness and other forms of intervention. Currently, systematic reviews on prognostic and etiological issues are commonly done. Systematic reviews are comprised by the following steps: formulation of the review question; definition of sources and search methods; definition and application of the trial selection criteria; critical analysis of selected studies; pooling and synthesis of trial data; and conclusions by inference. Lastly, a meta-analysis is a systematic review in which primary trial results are combined with statistical methods.
Systematic reviews on leptospirosis
GUIDUGLI, Fabio;CASTRO, Aldemar Araujo;ATALLAH, álvaro Nagib;
Revista do Instituto de Medicina Tropical de S?o Paulo , 2000, DOI: 10.1590/S0036-46652000000100008
Abstract: objectives: to find the existing clinical evidence on interventions for leptospirosis. the objective is to evaluate the effectiveness and safety of any intervention on leptospirosis through systematic reviews of randomized controlled trials (rcts). data source: the sources of studies used (where there were no limitations concerning language, date, or other restrictions) were: embase, lilacs, medline, the cochrane controlled clinical trials database, and the cochrane hepato-biliary group randomized trials register. selection of studies: type of study: all systematic reviews of randomized controlled trials. participants: patients with clinical and/or laboratorial diagnosis of leptospirosis, and subjects potencially exposed to leptospirosis as defined by the authors interventions: any intervention for leptospirosis (as antibiotics or vaccines for prevention or treatment). data collection: the assessment will be independently made by the reviewers and cross-checked. the external validity was assessed by analysis of: studies, interventions, and outcomes. data synthesis: located 163 studies using the search strategy described above, at the electronic databases above. only 2 hits were selected, which are protocols of systematic reviews of cochrane collaboration, and not full reviews. one of the protocols evaluates antibiotics for treatment, and the other evaluates antibiotics for prevention of leptospirosis. conclusions: there were not complete systematic reviews on interventions for leptospirosis. any interventions for leptospirosis, such as prevention and treatment remains unclear for guidelines and practice.
Systematic reviews on leptospirosis  [cached]
GUIDUGLI Fabio,CASTRO Aldemar Araujo,ATALLAH álvaro Nagib
Revista do Instituto de Medicina Tropical de S?o Paulo , 2000,
Abstract: OBJECTIVES: To find the existing clinical evidence on interventions for leptospirosis. The objective is to evaluate the effectiveness and safety of any intervention on leptospirosis through systematic reviews of randomized controlled trials (RCTs). DATA SOURCE: The sources of studies used (where there were no limitations concerning language, date, or other restrictions) were: EMBASE, LILACS, MEDLINE, the Cochrane Controlled Clinical Trials Database, and the Cochrane Hepato-Biliary Group Randomized Trials register. SELECTION OF STUDIES: Type of Study: All systematic reviews of randomized controlled trials. Participants: patients with clinical and/or laboratorial diagnosis of leptospirosis, and subjects potencially exposed to leptospirosis as defined by the authors Interventions: any intervention for leptospirosis (as antibiotics or vaccines for prevention or treatment). DATA COLLECTION: The assessment will be independently made by the reviewers and cross-checked. The external validity was assessed by analysis of: studies, interventions, and outcomes. DATA SYNTHESIS: Located 163 studies using the search strategy described above, at the electronic databases above. Only 2 hits were selected, which are protocols of systematic reviews of Cochrane Collaboration, and not full reviews. One of the protocols evaluates antibiotics for treatment, and the other evaluates antibiotics for prevention of leptospirosis. CONCLUSIONS: There were not complete systematic reviews on interventions for leptospirosis. Any interventions for leptospirosis, such as prevention and treatment remains unclear for guidelines and practice.
Statistical Multiplicity in Systematic Reviews of Anaesthesia Interventions: A Quantification and Comparison between Cochrane and Non-Cochrane Reviews  [PDF]
Georgina Imberger, Alexandra Damgaard Vejlby, Sara Bohnstedt Hansen, Ann M. M?ller, J?rn Wetterslev
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0028422
Abstract: Background Systematic reviews with meta-analyses often contain many statistical tests. This multiplicity may increase the risk of type I error. Few attempts have been made to address the problem of statistical multiplicity in systematic reviews. Before the implications are properly considered, the size of the issue deserves clarification. Because of the emphasis on bias evaluation and because of the editorial processes involved, Cochrane reviews may contain more multiplicity than their non-Cochrane counterparts. This study measured the quantity of statistical multiplicity present in a population of systematic reviews and aimed to assess whether this quantity is different in Cochrane and non-Cochrane reviews. Methods/Principal Findings We selected all the systematic reviews published by the Cochrane Anaesthesia Review Group containing a meta-analysis and matched them with comparable non-Cochrane reviews. We counted the number of statistical tests done in each systematic review. The median number of tests overall was 10 (interquartile range (IQR) 6 to 18). The median was 12 in Cochrane and 8 in non-Cochrane reviews (difference in medians 4 (95% confidence interval (CI) 2.0–19.0). The proportion that used an assessment of risk of bias as a reason for doing extra analyses was 42% in Cochrane and 28% in non-Cochrane reviews (difference in proportions 14% (95% CI ?8 to 36). The issue of multiplicity was addressed in 6% of all the reviews. Conclusion/Significance Statistical multiplicity in systematic reviews requires attention. We found more multiplicity in Cochrane reviews than in non-Cochrane reviews. Many of the reasons for the increase in multiplicity may well represent improved methodological approaches and greater transparency, but multiplicity may also cause an increased risk of spurious conclusions. Few systematic reviews, whether Cochrane or non-Cochrane, address the issue of multiplicity.
Room for improvement? A survey of the methods used in systematic reviews of adverse effects
Su Golder, Yoon Loke, Heather M McIntosh
BMC Medical Research Methodology , 2006, DOI: 10.1186/1471-2288-6-3
Abstract: In order to determine where methodological research is most needed to improve systematic reviews of adverse effects of health care interventions, we conducted a descriptive analysis of systematic reviews published between 1994 and 2005. We searched the Database of Abstracts of Reviews of Effects (DARE) and The Cochrane Database of Systematic Reviews (CDSR) to identify systematic reviews in which the primary outcome was an adverse effect or effects. We then extracted data on many of the elements of the systematic review process including: types of interventions studied, adverse effects of interest, resources searched, search strategies, data sources included in reviews, quality assessment of primary data, nature of the data analysis, and source of funding.256 reviews were included in our analysis, of which the majority evaluated drug interventions and pre-specified the adverse effect or effects of interest. A median of 3 resources were searched for each review and very few reviews (13/256) provided sufficient information to reproduce their search strategies. Although more than three quarters (185/243) of the reviews sought to include data from sources other than randomised controlled trials, fewer than half (106/256) assessed the quality of the studies that were included. Data were pooled quantitatively in most of the reviews (165/256) but heterogeneity was not always considered. Less than half (123/256) of the reviews reported on the source of funding.There is an obvious need to improve the methodology and reporting of systematic reviews of adverse effects. The methodology around identification and quality assessment of primary data is the main concern.While the assessment of adverse effects in systematic reviews of health care interventions is undoubtedly essential, there are significant methodological challenges in undertaking such reviews [1,2]. Some guidance is available from The Cochrane Collaboration [3] but the lack of empirical knowledge remains a major hand
Expediting systematic reviews: methods and implications of rapid reviews
Rebecca Ganann, Donna Ciliska, Helen Thomas
Implementation Science , 2010, DOI: 10.1186/1748-5908-5-56
Abstract: A comprehensive search strategy--including five electronic databases, grey literature, hand searching of relevant journals, and contacting key informants--was undertaken. All titles and abstracts (n = 1,989) were reviewed independently by two reviewers. Relevance criteria included articles published between 1995 and 2009 about conducting rapid reviews or addressing comparisons of rapid reviews versus traditional reviews. Full articles were retrieved for any titles deemed relevant by either reviewer (n = 70). Data were extracted from all relevant methodological articles (n = 45) and from exemplars of rapid review methods (n = 25).Rapid reviews varied from three weeks to six months; various methods for speeding up the process were employed. Some limited searching by years, databases, language, and sources beyond electronic searches. Several employed one reviewer for title and abstract reviewing, full text review, methodological quality assessment, and/or data extraction phases. Within rapid review studies, accelerating the data extraction process may lead to missing some relevant information. Biases may be introduced due to shortened timeframes for literature searching, article retrieval, and appraisal.This review examined the continuum between diverse rapid review methods and traditional systematic reviews. It also examines potential implications of streamlined review methods. More of these rapid reviews need to be published in the peer-reviewed literature with an emphasis on articulating methods employed. While one consistent methodological approach may not be optimal or appropriate, it is important that researchers undertaking reviews within the rapid to systematic continuum provide detailed descriptions of methods used and discuss the implications of their chosen methods in terms of potential bias introduced. Further research comparing full systematic reviews with rapid reviews will enhance understanding of the limitations of these methods.Healthcare increasingly
The implications of biomarker evidence for systematic reviews  [cached]
Choong Miew,Tsafnat Guy
BMC Medical Research Methodology , 2012, DOI: 10.1186/1471-2288-12-176
Abstract: Background In Evidence-Based Medicine, clinical practice guidelines and systematic reviews are crucial devices for medical practitioners in making clinical decision. Clinical practice guidelines are systematically developed statements to support health care decisions for specific circumstances whereas systematic reviews are summaries of evidence on clearly formulated clinical questions. Biomarkers are biological measurements (primarily molecular) that are used to diagnose, predict treatment outcomes and prognosticate disease and are increasingly used in randomized controlled trials (RCT). Methods We search PubMed for systematic reviews, RCTs, case reports and non-systematic reviews with and without mentions of biomarkers between years 1990–2011. We compared the frequency and growth rate of biomarkers and non-biomarkers publications. We also compared the growth of the proportion of biomarker-based RCTs with the growth of the proportion of biomarker-based systematic reviews. Results With 147,774 systematic reviews indexed in PubMed from 1990 to 2011 (accessed on 18/10/2012), only 4,431 (3%) are dedicated to biomarkers. The annual growth rate of biomarkers publications is consistently higher than non-biomarkers publications, showing the growth in biomarkers research. From 20 years of systematic review publications indexed in PubMed, we identified a bias in systematic reviews against the inclusion of biomarker-based RCTs. Conclusions With the realisation of genome-based personalised medicine, biomarkers are becoming important for clinical decision making. The bias against the inclusion of biomarkers in systematic reviews leads to medical practitioners deprive of important information they require to address clinical questions. Sparse or weak evidence and lack of genetic training for systematic reviewers may contribute to this trend.
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