Document classification Primary studies Secondry studies Primary studies

Document classification Primary studies Secondry studies

Primary studies Experimental studies Clinical trial studies Surveys studies

Secondry studies Reviews studies Guidlines studies Decision analysis Economic analysis

Narrative review �What is narrative review ? �its limitations: not all research gets published reluctance to publish clinical trials with negative results only 2/3 of published abstracts which can not provide methodology detail, get into print as full publication within a 2 year period

Systematic review �A comprehensive search for all relevant studies on a specific topic and those identified are then apprised and synthesized according to predetermined and explicit criteria

Background Glass 1976 Cochrane collaboration 1993

Cochrane systematic review protocole Review question Inclusion criteria Locate studies (Data bases) Select studies Assess study quality Extract data Analysis and present results

A good Systematic review 1. Focus on well defined question, stating the population, intervention, control groups and out comes 2. Reviewer should make a substantial effort to search for all literature relevant to question

A good Systematic review 3. The criteria for selecting or rejecting studies should be clearly stated and appropriate 4. The criteria used to assess the quality of primary studies should be clear

A good Systematic review 5. The process by which data was extracted from the primary studies should be transparent 6. A table illustrating the study characteristics of each included primary study should be presented.

A good Systematic review 7. Heterogeneity between studies should be explored and reasons for any variation discussed 8. Were data pooled qualitatively or statistically? 9. Interpreting the results

Sources of systematic reviews

Selected Electronic Health Information Resources Resource Internet Address ACP Journal Club www. acpjc. org Cochrane Library www. update-software. com Up. To. Date www. uptodate. com Pub. MED www. pubmed. com e. Medicine www. emedicine. com Clinical practice guidelines www. guidelines. gov MD Consult www. mdconsult. com EBMR Reviews (OVID) www. ovid. com/site/catalog

Cochrane Database �Limitations �limited to English �only addresses questions amenable to randomized trials �most of medicine has not been studied enough to allow for conclusions EBM Resources

Cochrane Databases The Cochrane Library is a collection of 6 main databases and 1 additional databases that describe Cochrane as an organization. These are: 1. 2. 3. 4. 5. 6. 7. 8. The Cochrane Database of Systematic Reviews (CDSR) The Cochrane Database of Reviews of Effects (DARE) The Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Database of Methodology Reviews (CDMR) Health Technology Assessment Database (HTA) NHS Economic Evaluation Database (NHS EED) THE COCHRANE METHODOLOGY REGISTER (CMR) About The Cochrane Collaboration and the Cochrane Collaborative Review Groups

EBD Method Assess your patient Acquire Ask clinical questions the best evidence Appraise the evidence Apply evidence to patient care

Problem with systematic reviews

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