Hilda Bastian NN/LM Pacific Southwest Region, webinar 10 April 2014 Systematic reviews and

Disclaimer This talk and these slides represent the work and opinions of the presenter, and do not constitute official positions of the National Center for Biotechnology Information (NCBI), the US National Library of Medicine (NLM), the National Institutes of Health (NIH) or the US Department of Health and Human Services (HHS).

 xxxx In 1840,the entire collection could have been held by a four-shelf bookcase, shoulder high and 7 or 8 feet wide. Figure: Bastian et al (see following)

Why we need systematic reviews: There is a lot to know  There are more than 75 trials a day & growing Bastian H, Glasziou P, Chalmers I. 75 trials & 11 systematic reviews a day: how will we ever keep up? PLoS Medicine (9):e

Conflicting information: the need for systematic reviews

 Medical research is doubling every 7 years; the number of medical-related journals is doubling every 20 years*  Trials on a topic could be published in hundreds of journals* – not all in the same database – and in registries  Only sophisticated searching can reduce the risk of missing important evidence * Hoffmann T, Erueti C, Thorning S, Glasziou P. The scatter of research: cross sectional comparison of randomised trials and systematic reviews across specialties. BMJ 2012; 344:e3223. Why we need systematic reviews: Research scatter

Systematic reviewing: Search flowchart * Horvath K, Koch K, Jeitler K, Matyas E, Bender R, Bastian H, Lange S, Siebenhofer A. Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. BMJ 2010; 340:c1395. Searched: Embase, Medline, AMED, BIOSIS, CCMed, CDMS, CDSR, CENTRAL, CINAHL, DARE, HTA, NHS EED, Heclinet, SciSearch, several publishers’ databases, and reference lists of relevant secondary literature

Why we need systematic reviews: Digesting data  Can’t juggle the results of multiple studies in different groups of people in your head reliably  Shortcuts are risky  Usually not as simple as a head count: 3 positive + 1 negative positive Cave: you often can’t combine data at all

What we mean by “systematic review”  Asks a structured, pre-specified question  Pre-specified, systematic methods for: - finding all potentially eligible studies - selecting which studies will be included - assessing quality of included evidence - synthesizing and interpreting results  Methods aim to minimize bias  May or may not include quantitative synthesis (meta-analysis)

Systematic reviews, CER, evidence-based…  PubMed Health concentrates on clinical effectiveness – but there are systematic reviews that answer other questions  CER can be “comparative effectiveness research” or “clinical effectiveness research”: may or may not be systematic reviews  Systematic reviews of systematic reviews: might be called overviews – might have both primary & secondary studies  “Rapid reviews”, “mini-reviews”, “evidence-based”  Guidelines, health technology assessments (HTA) and systematic reviews are not the same thing – except for the cases where they are!

Systematic reviews at NLM  Publication types “review” & “meta-analysis” but not “systematic review”  Hedged “Clinical Queries” filter for systematic reviews  PubMed Health, over 30,000 systematic reviews of health interventions from last 10 years via: DARE – Database of Reviews of Effects Cochrane Database of Systematic Reviews Curating health technology assessment (HTA) systematic reviews in partnership with HTA agencies

Links from PubMed to systematic reviews via

“Knowledge translation”  Efforts aiming to make the results of systematic reviews accessible – to consumers, clinicians, policymakers  Critical appraisal: efforts aiming to sift out the most reliable systematic reviews From AHRQ Effective Health Care Program:

PubMed Health Aims to:  Help people find systematic reviews  Understand what they find How:  Gathering systematic reviews, knowledge translation & educational materials for the public & clinicians Background articles – NLM Technical Bulletin:

Facets - primary “CER” search - Encyclopedia - Clinical Queries

Tips for systematic reviews & PubMed Health

First topic pages - drugs T /

First new topic pages – drugs

Just started – Health A-Z

Just started – Health A-Z: With anatomy, tests, symptoms, definitions…

Just started – Health A-Z: Will develop into a site-wide glossary

Helping people understand  Knowledge translation materials & medical encyclopedia  Section on “Understand Clinical Effectiveness” – includes educational articles & full text books  “Behind the Headlines”: critical appraisal of studies reported in the news  Tweets / Google+ / Facebook on clinical effectiveness concepts

Thanks! Google+