FACET - European Journal of Cancer Care September 2003 slides available at: Systematic Reviews and the Cochrane Collaboration MUNRO, A.J. 1 Slide One *Click on View; Notes Page for explanatory notes Who was Archie Cochrane, and why do we collaborate in his name? He was a public health physician whose ideas were ahead of their time: he was sceptical about the assumption that doctors always knew best; he thought that clinicians should justify their decisions, rather than simply be allowed to do whatever they felt like. Systematic Reviews and the Cochrane Collaboration

FACET - European Journal of Cancer Care September 2003 slides available at: Systematic Reviews and the Cochrane Collaboration (continued) Slide Two *Click on View; Notes Page for explanatory notes Archie Cochrane

FACET - European Journal of Cancer Care September 2003 slides available at: Systematic Reviews and the Cochrane Collaboration (continued) Slide Three *Click on View; Notes Page for explanatory notes The main problem identified by Cochrane Inflation: input rising much faster than output, costs of health care rising faster than any demonstrable improvements in health. Care and cure contrasted: the opportunity cost of inflation in cure sector is sub-standard services in the care sector. Solution: Make cure lean and efficient and there will be nourishment for care.

FACET - European Journal of Cancer Care September 2003 slides available at: Systematic Reviews and the Cochrane Collaboration (continued) Slide Four *Click on View; Notes Page for explanatory notes The agenda set by Cochrane for assessing an intervention Effectiveness - Does it work? Efficiency - Is it good value for money? Evaluation - Has it been properly tested? Equality - Can it be made available for everyone?

FACET - European Journal of Cancer Care September 2003 slides available at: Systematic Reviews and the Cochrane Collaboration (continued) Slide Five *Click on View; Notes Page for explanatory notes Evidence: problems of assembly and assimilation Overload There are around 23,000 journals publishing 2,000,000 papers in biology and medicine each year. These are published in a variety of languages and types of journals. To keep up with the ten leading medical journals requires looking at 200 papers and 70 editorials per month - each paper takes 30 to 60 minutes to read in detail. The paper mountain The biomedical literature produces a stack of papers growing at a rate of 2 km per year. 4 years worth is the height of Mount Everest.

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Six *Click on View; Notes Page for explanatory notes The nine values Collaboration Building on the enthusiasm of individuals Avoiding duplication Minimizing bias Keeping up to date Ensuring relevance Ensuring access Continually improving the quality of its work Continuity slides available at:

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Seven *Click on View; Notes Page for explanatory notes Components of the collaboration (1) Steering Group Collaborative review groups (CRGs) slides available at:

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Eight *Click on View; Notes Page for explanatory notes Components of the collaboration (2) Cochrane Centres Fields & Networks slides available at:

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Nine *Click on View; Notes Page for explanatory notes Components of the collaboration (3) Methods groups Consumer network slides available at:

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Ten *Click on View; Notes Page for explanatory notes What is the Cochrane Product? The Cochrane Library Database of systematic reviews - Reviews (1669) - Protocols (1266) Register of controlled clinical trials (362,540) Database of abstracts of reviews of effectiveness (DARE) (4006) Health technology assessment database (3138) Cochrane methodology register (4553) Database of methodology reviews (16) NHS economic evaluation database (11,485) slides available at:

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Eleven *Click on View; Notes Page for explanatory notes slides available at: A Systematic Review

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Twelve *Click on View; Notes Page for explanatory notes How reliable? 1998 quality review 15/53 reviews had major defects 9/53 evidence did not support conclusions 12/53 conduct or reporting unsatisfactory 12/53 problems with style slides available at:

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Thirteen *Click on View; Notes Page for explanatory notes Problems (1) Difficult to grasp the structure and vocabulary Recruitment and retention Costs and charging for library Consumer involvement Perceived Stalinism slides available at:

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Fourteen *Click on View; Notes Page for explanatory notes Problems (2) Publication/citation The mythical Albanian trial and the law of diminishing returns How do you assess evidence concerning interventions for which RCT is inappropriate or impossible (e.g. rare tumours)? Old trials test obsolete techniques slides available at:

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Fifteen *Click on View; Notes Page for explanatory notes Artze sind Überflussig (doctors are superfluous) slides available at:

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Sixteen *Click on View; Notes Page for explanatory notes Cochrane Collaboration – the real product slides available at:

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Seventeen *Click on View; Notes Page for explanatory notes Web based resources Much of the text used in this presentation has been adapted from the information available on the Cochrane Collaboration website. slides available at: The Cochrane manual provides considerable detail about the organisation and methods of the collaboration: it can be downloaded from: man.htm The Cochrane library can be found at: (access via this portal is limited, unless you or your institution have a password or gateway) If you are using a computer recognised as belonging to the UK NHS network you can access the full Cochrane library via: The Cochrane Reviewers handbook can be downloaded from: The Cochrane Cancer Network website is at:

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Eighteen *Click on View; Notes Page for explanatory notes Altman, D.G. (2001). Systematic reviews of evaluations of prognostic variables. Bmj (Clinical Research Ed.), 323: Antman, E.M., Lau, J., Kupelnick, B. et al (1992). A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. Journal of the American Medical Association. 268: Clarke, M. (2002). Commentary: searching for trials for systematic reviews: what difference does it make? International Journal of Epidemiology. 31: Cochrane, A.L. (1989). Effectiveness and Efficiency: random reflections on health services. The Rock Carling Fellowship BMJ Books. London. Cochrane, A.L. & Blythe, M. (1989). One Man's Medicine: An Autobiography of Professor Archie Cochrane. BMJ Books. London. slides available at: Other sources of information

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Nineteen *Click on View; Notes Page for explanatory notes Deeks, J.J. (2001). Systematic reviews in health care: Systematic reviews of evaluations of diagnostic and screening tests. Bmj (Clinical Research Ed.). 323: Dickersin, K. & Manheimer, E. (1998). The Cochrane Collaboration: evaluation of health care and services using systematic reviews of the results of randomized controlled trials. Clinical Obstetrics and Gynecology, 41: Dixon-Woods, M., Fitzpatrick, R. & Roberts, K. (2001). Including qualitative research in systematic reviews: opportunities and problems. Journal of Evaluation in Clinical Practice. 7: Easterbrook, P.J., Berlin, J.A., Gopalan, R. et al. (1991). Publication bias in clinical research. Lancet. 337: Egger, M., Davey Smith, G. & Altman, D.G. (2001). Systematic Reviews in Health Care: meta-analysis in context. BMJ Books. London. slides available at: Other sources of information (continued)

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Twenty *Click on View; Notes Page for explanatory notes Egger, M., Juni, P., Bartlett, C. et al (2003). How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technology Assessment (Winchester, England). 7: Egger, M., Zellweger-Zahner, T., Schneider, M. et al (1997). Language bias in randomised controlled trials published in English and German. Lancet. 350: Evans, D. & Pearson, A. (2001). Systematic reviews: gatekeepers of nursing knowledge. Journal of Clinical Nursing. 10: Grimshaw, J.M., Shirran, L., Thomas, R., et al (2001). Changing provider behavior: an overview of systematic reviews of interventions. Medical Care. 39; II2-45. Juni, P., Altman, D.G. & Egger, M. (2001). Systematic reviews in health care: Assessing the quality of controlled clinical trials. Bmj (Clinical Research Ed.). 323: slides available at: Other sources of information (continued)

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Twenty One *Click on View; Notes Page for explanatory notes Juni, P., Holenstein, F., Sterne, J. et al. (2002). Direction and impact of language bias in meta-analyses of controlled trials: empirical study. International Journal of Epidemiology. 31: Klassen, T.P., Wiebe, N., Russell, K. et al. (2002). Abstracts of randomized controlled trials presented at the society for pediatric research meeting: an example of publication bias. Archives of Pediatrics & Adolescent Medicine. 156: Linde, K. & Willich, S.N. (2003). How objective are systematic reviews? Differences between reviews on complementary medicine. Journal of the Royal Society of Medicine. 96: Macbeth, F. & Overgaard, J. (2002). Expert reviews, systematic reviews and meta-analyses. Radiotherapy and Oncology : Journal of the European Society For Therapeutic Radiology and Oncology. 64: slides available at: Other sources of information (continued)

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Twenty Two *Click on View; Notes Page for explanatory notes Moher, D. & Schachter, H.M. (2002). Potential solutions to the problem of conducting systematic reviews of new health technologies. Canadian Medical Association Journal 166: Olsen, O., Middleton, P., Ezzo, J., Gotzsche, P.C., Hadhazy, V., Herxheimer, A., Kleijnen, J. & McIntosh, H. (2001). Quality of Cochrane reviews: assessment of sample from Bmj (Clinical Research Ed.). 323: Petticrew, M. (2001). Systematic reviews from astronomy to zoology: myths and misconceptions. Bmj (Clinical Research Ed.). 322: Rothwell, P.M. (2002). Why do clinicians sometimes find it difficult to use the results of systematic reviews in routine clinical practice? Evaluation and the Health Professions. 25: slides available at: Other sources of information (continued)

FACET - European Journal of Cancer Care September 2003 Systematic Reviews and the Cochrane Collaboration (continued) Slide Twenty Three *Click on View; Notes Page for explanatory notes Shea, B., Moher, D., Graham, I. Et al. (2002). A comparison of the quality of Cochrane reviews and systematic reviews published in paper-based journals. Evaluation and the Health Professions. 25: Silagy, C.A., Middleton, P. & Hopewell, S. (2002). Publishing protocols of systematic reviews: comparing what was done to what was planned. Journal of the American Medical Association. 287: Sterne, J.A., Egger, M. & Smith, G.D. (2001). Systematic reviews in health care: Investigating and dealing with publication and other biases in meta-analysis. Bmj (Clinical Research Ed.). 323: Sutton, A.J., Duval, S.J., Tweedie, R.L. et al (2000). Empirical assessment of effect of publication bias on meta-analyses. Bmj (Clinical Research Ed.). 320: slides available at: Other sources of information (continued)