The Cochrane Library review titles that are important to users of health care,a Cochrane Consumer Network project

Background The Cochrane Consumer Network is an internet‐based community of international users of health care contributing to the work of The Cochrane Collaboration, whose mission is to inform healthcare decision making through development of systematic reviews of best evidence on healthcare interventions. Objective To prioritize existing review titles listed on The Cochrane Library from a healthcare user perspective, with particular emphasis on patients, carers and health consumers. Design An online survey was developed and after piloting was made available internationally. The broad dissemination strategy targeted Consumer Network members and Cochrane Review Group editorial staff to identify champions who notified patient support groups and participated in snowballing. The first part of the survey defined criteria that could be applied to review titles and asked survey respondents to rank them. The second part asked respondents to select a health area and prioritize review titles that were of importance to them. Each health area corresponded to a Cochrane Review Group. Results and discussion Sufficient responses were obtained from 522 valid responses to prioritize review topics in 19 health areas. A total of 321 respondents completed the titles assessment. The types of prioritized interventions were determined by the health area. An important observation was the emphasis on lifestyle and non‐medication therapies in many of the included health areas. The clearest exception to this broad observation was where acute care is required such as antibiotics for acute respiratory tract and HIV‐associated infections and for cardiac conditions. For some cancers, advanced cancer interventions were prioritized. The most important criteria were for the title to convey a clear meaning and the title conveyed that the review would have an impact on health and well‐being. The least important criteria were that the topic was newsworthy or prioritized in the healthcare system. Conclusion This project was able to identify priority Cochrane review topics for users of health care in 19 of the 50 areas of health care covered by The Cochrane Collaboration. Reviews addressing lifestyle and non‐medical interventions were strongly represented in the prioritized review titles. These findings highlight the importance of developing readable, informative lay summaries to support evidence‐based decision making by healthcare users.     

The Cochrane Collaboration: the role of the UK Cochrane Centre in identifying the evidence

This paper attempts to explain why systematic reviews of randomized controlled trials, based on as high a proportion as possible of the relevant studies, are so important in generating reliable information for evidence-based decision making within health care. The preparation, maintenance and dissemination of such reviews is the challenge which has been taken up by the Cochrane Collaboration. The first phase of data collection is the identification of relevant studies. Currently, bibliographic databases are inadequate for this task. MEDLINE searches identify on average only about half of the relevant studies, and until 1994 there were no suitable indexing terms in EMBASE to identify randomized controlled trials. Co-operation between the Cochrane Collaboration and both the National Library of Medicine and Elsevier, however, is already transforming this situation. From January 1994 a new indexing term has been added to EMBASE to help identify randomized controlled trials. From January 1995 a new indexing term will be added to MEDLINE to help identify controlled trials where the method of allocation to treatment or control cannot be described with certainty as being randomized. Also from January 1995 an additional 20,000 reports will be identifiable as randomized controlled trials in MEDLINE. Progress during the first 2 years of the Cochrane Collaboration has been encouraging, but much remains to be done if users of health services are to benefit from the evidence-based health care which they deserve.     

The Role of The Cochrane Collaboration in Support of the WHO Nutrition Guidelines

This article describes the background and contribution of The Cochrane Collaboration to the WHO Nutrition Guidelines program. Systematic reviews, augmented by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology for assessing the quality of a body of evidence, form the evidence basis for WHO guidelines. Our shared experience of working together has highlighted a number of issues that are challenging, such as decisions made about selecting appropriate questions for evidence synthesis and the nature of study types that are included, in particular the decision on whether or not to extend a search beyond randomized studies. Although the skills and experience required for evidence synthesis are different from those needed to determine recommendations for policy and practice, our experience suggests that some engagement between the two groups is mutually beneficial. Finally, our experience highlights the recognition that evidence of effectiveness is essential but by no means sufficient to guide decisions on recommendations. Programmatic and implementation considerations are important to guide decision making and the evidence basis for this may be limited; therefore, it is essential that groups involved in delivering interventions to populations are also engaged in the guidelines process.     

Literature review to identify factors that support implementation of evidence-based practice in residential aged care

The aim was to undertake a review of the literature on change management, quality improvement, evidence-based practice and diffusion of innovations to identify key factors that might influence the uptake and continued use of evidence in residential aged care. The key factors will be used to shape and inform the evaluation of the Encouraging Best Practice in Residential Aged Care Program which commenced in Australia in 2007. MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews were searched using combinations of search terms. Searching focused on existing literature reviews, discussions of relevant conceptual and theoretical frameworks and primary studies that have examined the implementation of evidence-based practice in residential aged care. Keyword searching was supplemented with snowball searching (following up on the references cited in the papers identified by the search), searching by key authors in the field and hand searching of a small number of journals. In general, the period covered by the searches was from 2002 to 2008. The findings from the literature are often equivocal. Analysis and consolidation of factors derived from the literature that might influence the implementation of evidence-based practice resulted in the identification of eight factors: (i) a receptive context for change; (ii) having a model of change to guide implementation; (iii) adequate resources; (iv) staff with the necessary skills; (v) stakeholder engagement, participation and commitment; (vi) the nature of the change in practice; (vii) systems in place to support the use of evidence; and (viii) demonstrable benefits of the change. Most of the literature included in the review is from studies in healthcare and hence the generalisability to residential aged care is largely unknown. However, the focus of this research is on clinical care, within the context of residential aged care, hence the healthcare literature is relevant. The factors are relatively broad and cover the evidence itself, the process of implementation, the context within which evidence will be implemented and the systems and resources to support implementation. It is likely that the factors are not independent of each other. The set of factors will be refined over the course of the evaluation.     

The efficacy of smoking cessation methods available in the Netherlands: a systematic review based on Cochrane data

OBJECTIVE: To obtain an overview of data from the Cochrane Library on smoking-cessation methods and aids available in the Netherlands. DESIGN: Systematic literature review. METHOD: Common smoking-cessation methods in the Netherlands in 1999 and 2000 were selected from previous research. Data from relevant Cochrane reviews about these cessation methods were collected, after which the efficacy was calculated as a pooled odds ratio and the effectiveness as a percentage of 12 months' continuous abstinence. RESULTS: The following methods were found to be more efficacious than placebo: tailored written advice, individual counselling, telephonic counselling, group courses, all forms of nicotine-replacement therapy, bupropion and nortriptyline. Acupuncture was not superior to placebo. It was not possible to draw any unequivocal conclusions about hypnotherapy. No randomised studies were found with respect to the 'Allen Carr method'. Rates of 12 months' continuous abstinence were as follows for those methods with proven efficacy: tailored advice: 7%, individual counselling: 16%, telephonic counselling: 7.5%, nicotine gum: 17%, nicotine patch: 13%, nicotine inhaler: 17%, nicotine tablets: 20%, bupropion: 17%, and nortriptyline: 24%. The success rates for nicotine tablets and nortriptyline were based on only 2 and 1 study respectively. CONCLUSION: Several effective smoking-cessation methods are available in the Netherlands. In trials the long-term effectiveness of these methods was between 7-24%.     

The use of nutritional 'positive deviants' to identify approaches for modification of dietary practices.

The paper describes methodology for doing nutrition surveys among deprived population groups of grossly homogeneous socioeconomic status so as to identify those families in which a child between age six months and five years falls in the upper 25 per cent in height and weight measurements. These families are labeled as being "Positive Deviants" from the undernutrition that prevails in the population. They are then studied anthropologically to uncover any practices related to food sources, storage, preparation, consumption, and content. The information would be used in designing food supplementation or other nutritional promotion in the population at large on the assumption that the observed "favorable" practices, although atypical, are feasible and culturally acceptable because they are indigenously rather than extraneously derived. In addition, the survey collected data on fertility because of findings concerning the close interrelatedness among a woman's nutritional state, her age when first giving birth, intervals between births, and the growth and development of her young children. Severe undernutrition raised a woman's safe age threshold for first birth above 20 years and a reasonably safe birth interval to more than three years.     

Development and pilot test of a process to identify research needs from a systematic review

ObjectiveTo ensure appropriate allocation of research funds, we need methods for identifying high-priority research needs. We developed and pilot tested a process to identify needs for primary clinical research using a systematic review in gestational diabetes mellitus.Study Design and SettingWe conducted eight steps: abstract research gaps from a systematic review using the Population, Intervention, Comparison, Outcomes, and Settings (PICOS) framework; solicit feedback from the review authors; translate gaps into researchable questions using the PICOS framework; solicit feedback from multidisciplinary stakeholders at our institution; establish consensus among multidisciplinary external stakeholders on the importance of the research questions using the Delphi method; prioritize outcomes; develop conceptual models to highlight research needs; and evaluate the process.ResultsWe identified 19 research questions. During the Delphi method, external stakeholders established consensus for 16 of these 19 questions (15 with “high” and 1 with “medium” clinical benefit/importance).ConclusionWe pilot tested an eight-step process to identify clinically important research needs. Before wider application of this process, it should be tested using systematic reviews of other diseases. Further evaluation should include assessment of the usefulness of the research needs generated using this process for primary researchers and funders.     

The Cochrane Library: a resource for current reviews of clinical evidence

The Cochrane Library is a tool for physicians and other health care practitioners seeking evidence to inform their decisions. The systematic reviews provide a high-quality synthesis of the current literature, saving time for busy people. To make the library more user-friendly, the collaboration plans to produce a consumer summary for each topic in the Database of Systematic Reviews and a cancer library aimed at the general public. In contrast to some of the questionable health-related resources on the Web, the Cochrane Library is an authoritative reference that can help physicians with everyday treatment decisions. The collaboration's commitment to keeping its resources up to date through vigorous support of reviewers should ensure that it remains a valuable Internet tool for physicians.