Converting systematic reviews to Cochrane format: a cross-sectional survey of Australian authors of systematic reviews

Background

Despite the growing reputation and subject coverage of the Cochrane Database of Systematic Reviews, many systematic reviews continue to be published solely in paper-based health care journals. This study was designed to determine why authors choose to publish their systematic reviews outside of the Cochrane Collaboration and if they might be interested in converting their reviews to Cochrane format for publication in the Cochrane Database of Systematic Reviews.

Methods

Cross-sectional survey of Australian primary authors of systematic reviews not published on the Cochrane Database of Systematic Reviews identified from the Database of Abstracts of Reviews of Effectiveness.

Results

We identified 88 systematic reviews from the Database of Abstracts of Reviews of Effectiveness with an Australian as the primary author. We surveyed 52 authors for whom valid contact information was available. The response rate was 88 per cent (46/52). Ten authors replied without completing the survey, leaving 36 valid surveys for analysis. The most frequently cited reasons for not undertaking a Cochrane review were: lack of time (78%), the need to undergo specific Cochrane training (46%), unwillingness to update reviews (36%), difficulties with the Cochrane process (26%) and the review topic already registered with the Cochrane Collaboration (21%). (Percentages based on completed responses to individual questions.) Nearly half the respondents would consider converting their review to Cochrane format. Dedicated time emerged as the most important factor in facilitating the potential conversion process. Other factors included navigating the Cochrane system, assistance with updating and financial support. Eighty-six per cent were willing to have their review converted to Cochrane format by another author.

Conclusion

Time required to complete a Cochrane review and the need for specific training are the primary reasons why some authors publish systematic reviews outside of the Cochrane Collaboration. Encouragingly, almost half of the authors would consider converting their review to Cochrane format. Based on the current number of reviews in the Database of Abstracts of Reviews of Effectiveness, this could result in more than 700 additional Cochrane reviews. Ways of supporting these authors and how to provide dedicated time to convert systematic reviews needs further consideration.

     

Differentiating positive and negative self-rated health: results from a cross-sectional study in Estonia

Objectives

To examine possible differences in the correlates of positive and negative self-rated health (SRH).

Methods

Data for 2,127 men and 2,385 women in the 25–74 age group came from the Estonian Health Interview Survey 2006. Multinomial logistic regression analysis was used to study the association of socio-demographic, physical and psychological health and well-being characteristics with positive (good or very good) and negative (bad or very bad) SRH as compared to fair SRH.

Results

Negative SRH was related to male gender, the presence of chronic illnesses, limitations in daily activities and physical functioning, emotional distress, an external locus of control, and to low satisfaction with life and physical fitness. These indicators (except satisfaction with life) were also related to positive SRH, presenting a mirrored pattern of association. Additionally, positive SRH was related to younger age, an Estonian ethnic identity, and to higher education and income.

Conclusions

Although SRH forms a ill/healthy continuum when physical and psychological health characteristics are considered, the broader spectrum of predictors indicates that positive SRH and negative SRH are two distinct and alternative concepts.     

Helicobacter pylori seroprevalence in hepatitis C virus positive patients with cirrhosis. The Como cross-sectional study.

BACKGROUND: Liver cirrhosis is a significant cause of death in Italy and one of the most frequent causes of hospitalization. Acute peptic ulcer and upper gastrointestinal bleeding reportedly occur in over 15% of cirrhotic patients. Since Helicobacter pylori (H. pylori) infection strongly correlates with peptic ulcer, we sought to ascertain the seroprevalence of H. pylori infection in cirrhotic patients. METHODS: In a cross-sectional study, we examined 52 consecutive patients (31 female and 21 male, age range 54-82, mean 68.7 years) suffering from hepatitis C virus (HCV)-related cirrhosis attending the Unit of Gastroenterology of the Valduce Hospital of Como (Italy). RESULTS: The prevalence of antibodies against H. pylori was 86.5% (45/52) in the cirrhotics. Of female patients 28/31 (90.3%) were seropositive as compared to 17 of 21 (80.9%) of male patients. CONCLUSIONS: The very high prevalence of H. pylori infection may explain the frequent occurrence of gastroduodenal ulcer in cirrhotic patients.     

A study of the references used in Cochrane protocols and reviews. Three bibles, three dictionaries, and nearly 25,000 other things

OBJECTIVES: To describe the types of report that are cited by protocols and reviews included in the Cochrane Database of Systematic Reviews. METHODS: The citation for each reference included in the Cochrane protocols and reviews published in the Cochrane Database of Systematic Reviews in issue 1, 1999 of The Cochrane Library were categorized by reference type (e.g., journal article, conference proceeding, book chapter, personal communication, Cochrane review). RESULTS: Of a total of 24,913 citations, 21,694 (87.1%) were references to journal articles. There was a significant difference between the proportion of references to studies that were journal articles (12,348 of 13,472; 91.7%) and the proportion of other references in this category (9,346 of 11,441; 81.7%). CONCLUSION: The great majority of studies included in Cochrane reviews at the beginning of 1999 had been published as journal articles.     

Children from low-income families have less access to sports facilities, but are no less physically active: cross-sectional study (EarlyBird 35)

Background Rising levels of childhood obesity have led to an increasing number of Government sponsored initiatives attempting to stem the problem. Much of the focus to date has been on physical activity and out‐of‐school activity in particular. There is an assumption that children from low‐income families suffer most where there is a lack of structured physical education in school. Accordingly, provision of additional facilities for sport and other forms of active recreation tend to target areas of socio‐economic deprivation. Aim We have assessed the relationship between parental income, the use of out‐of‐school sports facilities and the overall physical activity of young children across a wide socio‐economic range. Methods Total weekly physical activity was measured, objectively, over 7 days both at 7 years and 8 years in a healthy cohort of 121 boys and 93 girls using actigraph accelerometers. Questionnaires were used to establish parental income and parents reported the child's weekly use of out‐of‐school facilities for structured physical activity. Results Children from low‐income families attended significantly fewer sessions of structured out‐of‐school activities than those from wealthier families (r = 0.39), with a clear dose‐response relationship across income groups. Nevertheless, total physical activity, measured objectively over seven continuous days, showed no relationship between parental income and the mean activity level of the children (r = ?0.08). Nor did we find a relationship between parental income and time spent in higher intensity activity (r = ?0.04). Conclusion Social inequality appears to have little impact on physical activity in young children. Those from poorer families make less use of facilities for structured activity out‐of‐school but they nevertheless record the same overall level of activity as others. What they lack in opportunity they appear to make up in the form of unstructured exercise. Improving provision for sport may not lead to the expected rise in activity levels in young children.     

The characterisation of sexual behaviour in Chinese male university students who have sex with other men: A cross-sectional study

Background  

The risks for Chinese male university students who have sex with other men (MSM) have not been compared with those for non-MSM students. This information is important for the development of targeted HIV prevention programmes for this population.     

Using chart reviews to assess postpartum substance abuse. A pilot study

The use of chart reviews to assess substance use one-year postpartum was examined in this pilot study by comparing interviews with chart reviews for 23 women assessed positive for risk during pregnancy. There was no indication that providers asked about alcohol use in 83 percent of the charts, drug use in 57 percent of the charts, and tobacco use in 26 percent of the charts. Few positive or negative matches between interviews and chart reviews were found because substance use was generally not noted. These findings underscore the need to interview women to obtain postpartum substance use information and suggest that providers may not adequately address this issue.     

Trick,treat, or toy: children are just as likely to choose toys as candy on halloween

This study investigated whether children would choose toys over candy when offered both on Halloween. Seven households gave trick-or-treaters a choice between comparably sized toys and candies. The subjects (N = 284) were between 3 and 14 years of age. Children were just as likely to choose toys as candy. There were no gender differences. The implication of this study is that children will not be disappointed by toy treats on Halloween. In practice, nutrition professionals should encourage adults to create holiday traditions that do not rely on unhealthful foods.     

Fetal and maternal immune responses to methylmercury exposure: a cross-sectional study

Methylmercury (MeHg) is a ubiquitous environmental contaminant with known neurodevelopmental effects. In humans, prenatal exposures primarily occur through maternal consumption of contaminated fish. In this study, we evaluated the association between prenatal exposure to MeHg and titers of total immunoglobulins (Ig) and specific autoantibodies in both mothers and fetuses by analyzing maternal and cord blood serum samples. We examined multiple immunoglobulin isotypes to determine if these biomarkers could inform as to fetal or maternal responses since IgG but not IgM can cross the placenta. Finally, we evaluated serum cytokine levels to further characterize the immune response to mercury exposure.The study was conducted using a subset of serum samples (N=61 pairs) collected from individuals enrolled in a population surveillance of MeHg exposures in the Brazilian Amazon during 2000/2001. Serum titers of antinuclear and antinucleolar autoantibodies were measured by indirect immunofluorescence. Serum immunoglobulins were measured by enzyme-linked immunosorbent assay (ELISA) and BioPlex multiplex assay. Serum cytokines were measured by BioPlex multiplex assay.In this population, the geometric mean mercury level was within the 95th percentile for US populations of women of childbearing age but the upper level of the range was significantly higher. Fetal blood mercury levels were higher (1.35 times) than those in their mothers, but highly correlated (correlation coefficient [r]=0.71; 95% CI: 0.54, 0.89). Total IgG (r=0.40; 95% CI: 0.19, 0.62) and antinuclear autoantibody (odds ratio [OR]=1.05; 95% CI: 1.02, 1.08) levels in paired maternal and fetal samples were also associated; in contrast, other immunoglobulin (IgM, IgE, and IgA) levels were not associated between pairs. Total IgG levels were significantly correlated with both maternal (r=0.60; 95% CI: 0.25, 0.96) and cord blood mercury levels (r=0.61; 95% CI: 0.25, 0.97), but individual isotypes were not. Serum cytokines, interleukin-1β (r=0.37; 95% CI: 0.01, 0.73), interleukin-6 (r=0.34; 95% CI: 0.03, 0.65), and tumor necrosis factor-α (r=0.24; 95% CI: 0.015, 0.47), were positively correlated between maternal and fetal samples. Antinuclear and antinucleolar autoantibody titer and serum cytokine levels, in either maternal or cord blood, were not significantly associated with either maternal or cord blood mercury levels.These data provide further evidence that there are likely IgG biomarkers of mercury-induced immunotoxicity in this population since IgG levels were elevated with increased, and associated with, mercury exposure. However, unlike previous data from adult males and non-pregnant females, we found no evidence that antinuclear and antinucleolar autoantibody titer is a reliable biomarker of mercury immunotoxicity in this population.     

Pragmatic vs. explanatory: an adaptation of the PRECIS tool helps to judge the applicability of systematic reviews for daily practice

Objective

The Pragmatic-Explanatory Continuum Indicator Summary (PRECIS) tool was designed to classify randomized clinical trials (RCT) as being more pragmatic or explanatory. We modified the PRECIS tool (called PRECIS-Review tool [PR-tool]) to grade individual trials and systematic reviews of trials. This should help policy makers, clinicians, researchers, and guideline developers to judge the applicability of individual trials and systematic reviews.

Study Design and Setting

To illustrate the usefulness and applicability of the PR-tool, we applied it to two systematic reviews. Each included RCT was scored on the 10 PRECIS domains on a scale of 1-5. After this scoring, a 10-domain average for each individual trial and for the systematic review a single domain average and an overall average was calculated.

Results

One review was more pragmatic with an average score of 3.7 (range, 2.9-4.6) on our PR-tool, whereas the other review was more explanatory with an average score of 1.9 (range, 1.1-3.3). The results also suggest that the included studies within each systematic review were rather uniform in their approach, although some domains seemed more prone to heterogeneity.

Conclusion

The PR-tool provides a useful estimate that gives insight by estimating quantitatively how pragmatic each RCT in the review is, which methodological domains are pragmatic or explanatory, and how pragmatic the review is.     

Honey,I shrunk the pooled SMD! Guide to critical appraisal of systematic reviews and meta-analyses using the Cochrane review on exercise for depression as example

ProblemIn several countries, physical activity is now recommended in clinical practice guidelines as an option for the treatment of subthreshold, mild, and moderate adult depression. However, most physicians do not present this option to their patients, attributing their decision to the perception that the supporting research evidence is inadequate. To assist readers in developing a strategy for evaluating pertinent research evidence, the present analysis offers a critical appraisal of the Cochrane systematic review and meta-analysis examining the effects of exercise on depression. Remarkably, successive updates of this review have reported a gradual “shrinkage” of the pooled standardized mean difference associated with exercise by 44%, from −1.10 in 2001 to −0.62 in 2013.MethodThe analysis evaluated the inclusion and exclusion criteria, the uniformity of rules, the rationale behind protocol changes, the procedures followed in assessing methodological quality, and reporting errors.ResultsInspection of the details of the review demystifies the “shrinkage” phenomenon, revealing that it is attributable to specific, questionable methodological choices and the fluidity of the review protocol. Reanalysis of the same database following rational modifications shows that the effect of exercise is large. Restricting the analysis to high-quality trials yields an effect size significantly different from zero.ConclusionsAlthough the clinical value of the Cochrane review is questionable, its educational potential is undeniable. Clinicians, students, referees, editors, systematic reviewers, guideline developers, and policymakers can use the present analysis as a template for evaluating the influence of methodological choices on the conclusions of systematic reviews and meta-analyses.