Tag: cochrane collaboration

#revScreen – Cochrane Crowd Challenges on home visiting and medical education

Previously I blogged about the addictive nature of EMBASE Screening. This is now rebranded as Cochrane Crowd, but the overall approach is unchanged – the user assesses abtracts to see if they are RCTs/CCTs or not. It it surprisingly addictive.

cochrane crowd logo

 

Anyhow, there are two new Cochrane tasks – screening for RCTs for two specific reviews Home visiting for socially disadvantaged mothers, and  Interventions for improving medical students’ interpersonal communication in medical consultation. 

If any readers are interested in these areas, the Cochrane Crowd process exposes one to a wide range of (at times rather tenuously related) studies and papers on the topic… I tend to get sidetracked easily.

Anyhow, here is the email:

Dear all,

 

We need your help!

 

When you next log into Cochrane Crowd you will be able to see two new ‘tasks’ in your dashboard area. One is for an update of a review entitled: Home visiting for socially disadvantaged mothers, and the other is for a new review, called: Interventions for improving medical students’ interpersonal communication in medical consultations.

 

The searches for each of these reviews has identified between 3000-5000 records. The core author team for each review has come toCochrane Crowd asking if this community can help. I think we can.

 

Before you dive in, here are some questions you might have:

 

What do I need to do that is different from the usual RCT screening task?

Absolutely nothing. The task is exactly the same making you very well qualified to help! We want all the randomized or quasi-randomized trials to be identified even if the trial has nothing to do with the topic of the review.

 

What’s in it for me?

For those who screen 250 or more records, your contribution will be acknowledged in the review for which you contributed. In addition, on one of the reviews, the home visiting review, the review team will reward authorship to the top screener. This will be based not just on the amount you screen but the accuracy of your screening.

 

How long will these tasks be posted for?

We’ve set the deadline for 31st March. It would be fantastic to have both sets of records screened by that date.

 

Who can I contact if I have any questions or queries?

You can either contact me, Anna, (anna.noel-storr@rdm.ox.ac.uk) or my brilliant colleague, Emily (crowd@cochrane.org) and we’ll try and get back to you as quickly as possible.

 

Do I need to let anyone know if I plan to contribute or not?

No, you don’t need to let us know either way. If you want to contribute to either or both reviews, just log into Crowd and get cracking! We’ll know who has taken part. Likewise, if this just isn’t for you or you don’t think you’ll have the time, that’s absolutely fine; you don’t need to let us know.

 

When can I start?

Right now! Go and make a nice cup of tea and hop over to Cochrane Crowd (http://crowd.cochrane.org). Log in as usual and you should see the two new tasks. I think I’ll head there now myself.

If you’re a twitterer, we’ll be using #RevScreen for these two exciting pilots!

 

With best wishes to all and happy citation screening,

 

 

Anna and Emily

 

Cochrane Crowd

 

Evidence based medicine and evidence based policy

There was a fair bit of media coverage of the finding that teenage-pregnancy-prevention programmes using simulated babies are associated with an increased rather than decreased teenage pregnancy rate. Some of the media discussion focused on the role of evidence in public policy.

Via Twitter, I came across this article on evidence-based policy by Howard White in The Independent

Evidence-based medicine has transformed medical practice. TheCochrane Library has published more than 6,000 studies summarising high quality evidence for health interventions. Notable cases include breast screening, which used to be recommended for women from the age of 40 until the evidence showed that the number of false positives recorded was in fact doing more harm than good. The risks from unnecessary surgery were greater than the often small benefits from early treatment forbreast cancer.

Hormone replacement therapy (HRT) is another example. It was routinely used to reduce heart disease, but then became far less common when evidence showed adverse effects. There is now a more nuanced understanding of which women will benefit from HRT and which will not.

Prior to Cochrane, doctors based their advice on out-of-date knowledge, personal experience and the influence of drug reps. Today, doctors have access to evidence-based guidelines. Decisions on what the NHS can and should fund are informed by the advice of the National Institute for Health Clinical Excellence after a review of the evidence.

So why can’t we do the same for social and economic policy?

For those who are interested, I engaged (or am engaging) in a twitter exchange on this with Howard White, whose replies have been very gracious. As in so many of these exchanges I suspect that we agree on more than we disagree on (and possibly agree on everything with a difference in emphasis)

Of course policy should be based on evidence, where available. This not only seems extremely reasonable and  rational – it is eminently reasonable and rational. I also write as an admirer of the Cochrane Collaboration.

However, I always feel a sense of caution when clinical concepts are introduced into political discourse. The best definitions of EBM always include the word “judicious”, as here

“Evidence-based medicine is the conscientious explicit and judicious use of current best evidence in making decisions about the care of individual patients.”

Judicious is key – judgment and reflection are required. Does this body of evidence apply to my patient, this individual person in front of me, or does it not? As I wrote on another point:

it is one thing to have an evidence base for a specific therapy in medical practice, quite another for a specific intervention in society itself.

My review of Helen Pearson’s The Life Project is still to be published, when it does I will perhaps write a little more on “evidence-based policy”, a concept which began to enjoy great vogue in the 1990s.What Pearson’s book shows, however, is that the devil can cite evidence for his own purpose; “evidence” can be wielded with agendas.

Obviously the Campbell Collaboration aims to address this, by being transparent about the evidence used and the methodology used to synthesise it.

A further point is that evidence-based policy tends to presuppose consensus on the ends of policy  – and emphasise technocratic means of getting there. Thereby the focus on specific interventions, rather than any wider sense of not merely social goals but of social meaning. Of course, this very much in keeping with a time in which we are all supposed to be beyond “grand narratives” – which is of course itself a “grand narrative.” I would suggest that many recent events in politics around the world are best understood as testing this notion to destruction.

Bringing it all back to a question I asked a while ago about the best kind of evidence for health informatics innovations, perhaps what this illustrates is that the way we do evidence now tends to be to focus on specific interventions and, as far as possible, measure their effects as specific interventions and without reference to an overall system. Indeed, this is obviously necessary for assessing therapies and treatments. But is it necessarily missing something when it comes to a system?

I have finished Evidence Based Medicine (for a while)

This evening, I logged on to do some Embase screening:

embase

Noting that there were a mere 100 records to screen, I worked away for a while, until:

embaseoneleft

 

With bated breath I screen the one remaining record (naturally enough, a Reject verdict), and after a bit of deliberation clicked on “Save and Exit”, to discover that :

victoryembase

 

Of course, I know that a gigantic batch of records will no doubt be delivered to Embase for screening, if it hasn’t already (and I am probably misunderstanding something even more basic) but, for the moment, there is a pleasing sensation of having reached the ultimate extreme of human knowledge (only mild hyperbole here!)

My struggle against EMBASE Screening addiction

Ok, the headline is a little glib, and I don’t want to make fun of any actual addiction – but since discovering EMBASE screening at a HRB TMRN event on systematic reviews on Thursday last, I’ve been hooked.
EMBASE screening is very simple – as the Cochrane Collaboration Community Page on the project states “The project’s purpose is to identify reports of randomised controlled trials (RCTs) and quasi-RCTs from EMBASE for publication in the Cochrane Central Register of Controlled Trials (CENTRAL)” Put simply , “The EMBASE project provides an opportunity for new and potential contributors to get involved with Cochrane work by diving into a task that needs doing. No prior experience is necessary as the task supports a ‘learn as you do’ approach. ”

 

Basically the screener is presented with a title and abstract (occasionally just a title) and has to decide if this is an RCT/quasi-RCT, definitely not an RCT/quasi-RCT, or impossible to tell. There are lots of checks and balances so one shouldn’t worry about making a mistake. The interface is very simple and a good, clear training module is provided before you get stuck it.

This is a much better way of passing a few minutes with a smart phone than checking news sites again or again, or whatever your poison is…. and along the way I have come across some intriguing abstracts such as this and this (neither of which is a RCT)