Writing a systematic review following Cochrane methods

Trusted evidence. Informed decisions. Better health. Course learning objectives

• understand general methods required to prepare a Cochrane Review • able to draft a protocol for a Cochrane Review • know where to find further assistance Course outline: Day 1

• introduction to writing a Cochrane Review • defining your review question • writing a protocol • searching for studies • selecting studies • assessing risk of bias in included studies The Cochrane Handbook for Systematic Reviews of Interventions

• essential guidance for entire review process • available • online www.cochrane.org/handbook – also lists what’s new and future corrections • via Help menu in RevMan

Look out for pointers to relevant chapters Session outline

• introduction to Cochrane • aims and structure of Cochrane Reviews • logistics of writing a review

See Chapter 1 of the Handbook Archie Cochrane’s challenge

“It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials.” A. Cochrane 1979

Photograph: Cardiff University Library, Cochrane Archive, University Hospital Llandough Vision and mission

Our vision is a world of improved health where decisions about health and health care are informed by high-quality, relevant and up-to-date synthesized research evidence.

Our mission is to promote evidence-informed health decision-making by producing high-quality, relevant, accessible systematic reviews and other synthesized research evidence. An international organisation

http://www.cochrane.org/contact/centres Session outline

• introduction to Cochrane • aims and structure of Cochrane Reviews • logistics of writing a review Why systematic reviews?

• efficient way to access the body of research • saves time required for searching • critical appraisal • interpretation of results • explore differences between studies • reliable basis for decision making • unbiased selection of relevant information • useful for health care, policy, future research Key features of a systematic review

• clearly stated objectives • pre-defined eligibility criteria • explicit, reproducible methodology • systematic search • assessment of validity of included studies • systematic synthesis and presentation of findings Steps of a Cochrane Review 1. define the question register title 2. plan eligibility criteria 3. plan methods publish protocol 4. search for studies 5. apply eligibility criteria 6. collect data 7. assess studies for risk of bias 8. analyse and present results 9. interpret results and draw conclusions publish review 10. improve and update review publish update Session outline • introduction to Cochrane • aims and structure of Cochrane Reviews • logistics of writing a review

See Chapter 2 of the Handbook Motivation

• resolve conflicting evidence • support practice • address uncertainty • explore variations • confirm current practice (or not) • identify need for future research

Summarize evidence to help people make decisions The review team

• review must be undertaken by more than one person • allows double-checking – eligibility of included studies – data collection and entry – risk of bias assessment • different areas of expertise – clinical (multidisciplinary) – systematic review methods (including statistics) – user perspective (consumer, professional, settings) • complete a review proposal form • consider establishing an advisory group Cochrane editorial processes

• registration – prevents duplication – ensures topics are appropriate and clear • ongoing support – first point of contact for questions as they arise – standard methods and review text – templates (e.g. data collection forms) – literature searching – statistical expertise • publication – peer review – decision whether or not to publish Declaration of interest • not permitted: – a review funded or conducted by commercial organization with a vested interest in the findings – an author directly employed by a commercial organisation with an interest in the intervention – an author who holds a patent relating to the intervention • declare other potential conflicts • financial (all sources of funding & in-kind support) – personal (e.g. authorship of a potentially included study, practice in a clinical area) • decisions at the discretion of the Funding Arbiter http://community.cochrane.org/editorial-and-publishing-policy- resource/ethical-considerations/conflicts-interest-and-cochrane-reviews Resources for your review

• time – how much time does each author have? – what tasks need to be done? by whom? – how long will each task take? – up to 1-2 years in total • expertise – library (database access, interlibrary loans, advice) – statistical • office supplies and technology – computers, internet access, phone calls/conferences, printing, photocopying Review Manager (RevMan)

• mandatory software • access your review from the Archie database • template for protocol or review structure • write the text of your review • statistical analysis • editorial and publication • need a Cochrane Account • ask your CRG • http://community.cochrane.org/tools/review-production-tools/revman-5

See User Guide and Tutorial on the RevMan Help menu Online Learning Modules

http://training.cochrane.org/path/introduction-systematic-reviews-pathway Sources of information

• The Cochrane Library http://www.cochranelibrary.com/ • Cochrane website http://www.cochrane.org/ • CRG websites http://www.cochrane.org/contact/review-groups • if unsure, contact your reference Centre http://www.cochrane.org/contact/centres Take home message

• Cochrane Reviews aim to provide reliable information to support healthcare decisions • your first point of contact is the relevant Cochrane Review Group (CRG) • start by putting together a team and thinking about your resources References Green S, Higgins JPT, Alderson P, Clarke M, Mulrow CD, Oxman AD. Chapter 1: Introduction. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from http://community.cochrane.org/handbook Green S, Higgins JPT (editors). Chapter 2: Preparing a Cochrane review. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from http://community.cochrane.org/handbook Cochrane AL. 1931-1971: a critical review, with particular reference to the medical profession. In: Medicines for the year 2000. London: Office of Health Economics, 1979, 1-11. Acknowledgements

• Compiled by Miranda Cumpston • Based on materials by Cochrane Australia and Cochrane Canada • Approved by the Cochrane Methods Board