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Development of   Cochrane Rapid Response           (Part 1)• Chantelle Garritty, Centre for Practice-Changing Research,  O...
Context Our Knowledge Synthesis Group is part of the Ottawa Methods  Centre (OMC), Clinical Epidemiology Program at the C...
ObjectivesPart 1.   • Share the history of our involvement with Cochrane Rapid      Response        •By briefly introducin...
Brief history of our involvement withrapid reviews.....
Background• For over the last two years our group has explored the:   • Methods;   • Execution; and   • Teaching of rapid ...
Partner wanted energies directed to             ‘Push Activities’• LHIN was looking for expedient  evidence-based answers ...
Through our 2-year CIHR KTA research grant, we began to dive into the realm of            „rapid reviews.‟
Rapid ReviewsWe know….• Policymakers and healthcare stakeholders are increasingly  seeking evidence to inform the policyma...
However, no universally accepted         definition of rapid review• Closest we‟ve come to a definition:   • Rapid review ...
Scoping Exercise of Rapid Reviews                     (Ganann et al 2010)Findings from 70 studies that authors looked at:•...
KTA Project with the Champlain LHIN
Rapid Review Methods Essentially developed an abbreviated & accelerated version  of current SR methods Borrowing from Co...
Overview of our Rapid ReviewMethodology…
Rapid reviews: From start to finish        it was an 8-stage approach…1.   Needs assessment (with stakeholders)2.   Questi...
1. Needs assessment• Stage starts with a probing consultation with a knowledge user  with a problem/question (1 hr of upfr...
2. Question development and refinement• Generally, formulating appropriate research questions not a  strong suit of knowle...
Guidance for Question FormulationFor interventions, for example PICO (TS) Format   Population (participants)   Interventio...
3. Proposal development and approval• Need for a formal document to succinctly summarize the  outcomes of the needs assess...
4. Systematic literature search • A comprehensive search is conducted by an information specialist   (MEDLINE® + Cochrane)...
5. Screening and selecting studies• First, download searches to Reference Manager® - a  bibliometric database management s...
5. Screening and selecting studies• For questions of treatment effectiveness –emphasis placed on locating  & summarizing e...
6. Narrative synthesis of included studies• Designed to provide knowledge users with a sense of the  volume and direction ...
7. Report production
Disclaimer page        The information in this report is a summary of available material and is designed to givereaders (h...
Snapshot of Rapid Review report
Primary research question as the title   Informative sidebar outlines theintended audience and explains the      nature of...
Table of contents indicates each sub-  section pertaining to the questionBrief background information on the     subject m...
Brief summary of    the methods         used:searches; sources; eligibility criteria;     screening/extraction methods;   ...
8. Ongoing follow-up with end users• Input on final edits of penultimate drafts• Provides confirmation no material missing...
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Development of Cochrane Response part 1

by Chantelle Garritty, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Canada

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Development of Cochrane Response part 1

  1. 1. Development of Cochrane Rapid Response (Part 1)• Chantelle Garritty, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada October 2012
  2. 2. Context Our Knowledge Synthesis Group is part of the Ottawa Methods Centre (OMC), Clinical Epidemiology Program at the Centre for Practice-Changing Research based at the Ottawa Hospital Research Institute (OHRI); Academic group (n=25) engaged exclusively in knowledge syntheses and related methods research led by Dr. David Moher; Our group is home to several initiatives (Cochrane Bias Methods Group; CONSORT, PRISMA and other reporting guideline initiatives; KS Canada Network (CIHR); CIHR/Health Canada Network Meta-analysis Centre; AHRQ EPC (2002- 2012; several years working on developing methodology for updating SRs; and most recently rapid reviews Methods research is a cornerstone of our work
  3. 3. ObjectivesPart 1. • Share the history of our involvement with Cochrane Rapid Response •By briefly introducing the rapid review methodology we developed for a „knowledge to action‟ (KTA) programPart 2. • Discuss output from of this KTA program including initial impressions of the rapid reviews • New rapid review initiatives we‟ve become involvedPart 3. • Cochrane Rapid Response – the specifics
  4. 4. Brief history of our involvement withrapid reviews.....
  5. 5. Background• For over the last two years our group has explored the: • Methods; • Execution; and • Teaching of rapid reviews across various healthcare topics• Started with a local partnership with Champlain Local Health Integrated Network (LHIN), which is 1 of 14 LHINs in the province of Ontario, which are responsible for planning, coordinating and funding health services in locally.• Applied for CIHR – Knowledge to Action (KTA) grant for funds and were successful (Sept. 2009-2011)
  6. 6. Partner wanted energies directed to ‘Push Activities’• LHIN was looking for expedient evidence-based answers to help direct policy, implementation, and Push practice decisions to best meet their Activities information needs [Knowledge• As a result, a series of rapid evidence Intelligence summaries were produced (4-6 wks) Services in response to clinical and health e.g., Rapid services questions developed with Reviews, Horiz LHIN managers and stakeholders on Scanning]
  7. 7. Through our 2-year CIHR KTA research grant, we began to dive into the realm of „rapid reviews.‟
  8. 8. Rapid ReviewsWe know….• Policymakers and healthcare stakeholders are increasingly seeking evidence to inform the policymaking process• They often require rapid access to high-quality evidence to inform decisions on emergent issues or questions• As such, there‟s been an increase in use of rapid review- type products
  9. 9. However, no universally accepted definition of rapid review• Closest we‟ve come to a definition: • Rapid review (RR) is a type of literature review produced using accelerated and streamlined systematic review (SR) methods • Using various means to short circuit the system
  10. 10. Scoping Exercise of Rapid Reviews (Ganann et al 2010)Findings from 70 studies that authors looked at:• RRs employ a variety of methodologies;• Variety of different labels (rapid reviews, HTAs; evidence summaries; ultra rapid reviews);• Seem to vary in depth of description of methods used to abbreviate the process;• Few discussed limitations (what was lost) or what bias was potentially introduced by using RR methods
  11. 11. KTA Project with the Champlain LHIN
  12. 12. Rapid Review Methods Essentially developed an abbreviated & accelerated version of current SR methods Borrowing from Cochrane but having to make certain concessions compared to a traditional SR to accommodate expedited turnaround time (4-6 weeks) Out of which emerged an 8-step rapid review process developed iteratively across development of 19 „Evidence Summaries‟ within a 24-month span
  13. 13. Overview of our Rapid ReviewMethodology…
  14. 14. Rapid reviews: From start to finish it was an 8-stage approach…1. Needs assessment (with stakeholders)2. Question development and refinement (PICO/TS)3. Protocol development and approval4. Systematic literature search (with limits)5. Screening and selection of studies (with limits)6. Narrative synthesis of included studies (no meta-analysis)7. Report production phase8. Ongoing follow-up with end users Objective: high rigour, transparency, and usability
  15. 15. 1. Needs assessment• Stage starts with a probing consultation with a knowledge user with a problem/question (1 hr of upfront time);• Purpose is to ascertain the following: • Scope of the question • Purpose for which it will be used • Availability and commitment of the knowledge user over the course of the project• This phase forms the cornerstone of the evidence summaries from the beginning• Serves the dual role of 1) determining if scope fits our proposed methods, and 2) ensures final product is meaningful for intended audience (dynamic approach)
  16. 16. 2. Question development and refinement• Generally, formulating appropriate research questions not a strong suit of knowledge users• Usually clear about broad strokes in terms of what they want to ask but less able to provide critical details that make a research question precise and answerable• Routinely now require an additional 1-2 hrs upfront to flesh out question, and applicability of RR approach• Work to operationalize questions collaboratively (vetting process): • Use the PICOS framework as reasonably as possible (effectiveness) • Modify accordingly (health systems and/or health services related questions)
  17. 17. Guidance for Question FormulationFor interventions, for example PICO (TS) Format Population (participants) Intervention Comparator Outcome Time (duration) Study design (experimental / observational, N)• Frames clinical questions providing a clearly specified scope• Aim is for a manageable question that can be tackled within the condensed timeframe that is still able to provide a meaningful answer to the end user
  18. 18. 3. Proposal development and approval• Need for a formal document to succinctly summarize the outcomes of the needs assessment and question refinement stages• A summary of discussed question and methods• Use template to maximize efficiency (2-4 pages) [Sections: background; finalized research question(s); proposed methods; deliverables; timelines; „knowledge user role‟ section – few lines of text that emphasizes the importance of their involvement – what is required of them]• Serves as a point of reference for the end users and research team (and allows early identification of possible misinterpretation)• Informs extended members of the research team (e.g. information specialist, research assistants)
  19. 19. 4. Systematic literature search • A comprehensive search is conducted by an information specialist (MEDLINE® + Cochrane) – topic dependent but usually no more than 2-3 key databases • Depending on search outcomes, can be a possible point at which to revisit the eligibility criteria based on identified evidence base (e.g., magnitude, complexity, available study designs) COMMON ELIGIBLITY RESTRICTIONSCriteria Include JustificationLANGUAGE 1. English only 1. No time to translatePUBLICATION STATUS 1. Full text only 1. Potential bias from abstracts 2. Electronically available 2. No time for ILL from UOttawa library 3. Grey literature 3. Greater depth; curb publication biasPUBLICATION DATE 1. Published > [date] 1. Increase clinical relevance; reduce evidence to manageable loadGEOGRAPHICAL 1. „Western‟ context or 1. Increase clinical relevanceLOCATION „Canadian‟ context
  20. 20. 5. Screening and selecting studies• First, download searches to Reference Manager® - a bibliometric database management software• Search strategies, dates, yields and duplicate counts recorded in a formal search log• References then uploaded to an Internet-based systematic review software (DistillerSR®) to facilitate screening• Screening undertaken by two independent reviewers • title/abstracts (level 1); full-texts (level 2)• Another point at which the eligibility criteria may need to be refined. This will depend on: • Volume of evidence • Applicability of evidence to end users context and needs
  21. 21. 5. Screening and selecting studies• For questions of treatment effectiveness –emphasis placed on locating & summarizing evidence from relevant, high quality SRs • Aims to: • Limit unnecessary duplication of also including primary studies • Minimize resources needed to screen and summarize primary studies quickly• In absence of SRs, our approach may cautiously include: • High quality RCTs • High quality quasi-experimental and/or observational studies • Landmark, recent, and/or oft-cited studies• However, with refinement of our approach and emphasis on more narrow questions, recent summaries have almost exclusively drawn from evidence reported in SRs
  22. 22. 6. Narrative synthesis of included studies• Designed to provide knowledge users with a sense of the volume and direction of the available evidence• No formal quantitative synthesis (e.g., meta-analysis)• Synthesis presents main components of included studies (e.g., SRs): • Primary objectives • Primary methods • Primary findings • Main conclusions • Limitations – when applicable • Risk of bias assessment (AMSTAR scores)• Bottom line summaries provided – for each section• These are fed into overall report – key messages
  23. 23. 7. Report production
  24. 24. Disclaimer page The information in this report is a summary of available material and is designed to givereaders (health systems stakeholders, policy and decision makers) a starting point in consideringcurrently available research evidence. Whilst appreciable care has been taken in the preparationof the materials included in this publication, the authors do not warrant the accuracy of thisdocument and deny any representation, implied or expressed, concerning the efficacy,appropriateness or suitability of any treatment or product. In view of the possibility of humanerror and advances of medical knowledge, the authors cannot and do not warrant that theinformation contained in these pages is current, accurate or complete. Accordingly, they shallnot be responsible or liable for any errors or omissions that may be found in this publication.You should consult other sources in order to confirm the currency, accuracy and completenessof the information contained in this publication and, in the event that medical treatment isrequired you should take professional expert advice from a legally qualified and appropriatelyexperienced medical practitioner. Disclosure upfront that this is not intended to be a gold standard SR, and therefore needs to be interpreted with caution and viewed within a specific context for a specific end user
  25. 25. Snapshot of Rapid Review report
  26. 26. Primary research question as the title Informative sidebar outlines theintended audience and explains the nature of included content “Key messages” section aims to summarize overall findings Intended to capture the attention of the end user as it may be all they read
  27. 27. Table of contents indicates each sub- section pertaining to the questionBrief background information on the subject matter is presented Systematic review evidence is highlighted per question (includes AMSTAR rating)“Bottom lines” aim to summarize the evidence under each sub-section
  28. 28. Brief summary of the methods used:searches; sources; eligibility criteria; screening/extraction methods; study types Conflicts of included interest Acknowledgements Reference to ROB (AMSTAR tool) Authors/ Cited
  29. 29. 8. Ongoing follow-up with end users• Input on final edits of penultimate drafts• Provides confirmation no material missing/misinterpretation of the evidence• Ascertain (informal) feedback on the quality and usability of the report (email, conversation)• Post-hoc have sought formal feedback on summaries and the KTA program in general during 30min-1hr interviews with end users
  30. 30. Moving onto Part 2….

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