How to read a Cochrane review. The Basics. - EUMASS · 2019-03-27 · How to read a Cochrane...

Research Center for Insurance Medicine: collaboration between AMC-UMCG-UWV-VUmc

How to read a Cochrane review.

The Basics.

Jan Hoving, Regina Kunz, Emilie Friberg, Frederieke Schaafsma


Workshop - How to read a Cochrane review

This workshop:

- Workshop setup: ‘question and answer’ format

- Material: a. Published Cochrane Review (van Vilsteren, short version)

b. Question sheet

What are we going to do?

1. Read summary of Cochrane review (10 min)

2. Read questions and discuss answer with neighbor (20 min)

3. Plenary discussion using input participants + additional

explanation presenters (60 min)


What is the Cochrane Collaboration?

The Cochrane Collaboration

• Organisation

• global network of 90 entities such as review groups

• involves about 30.000 volunteers all over the world

• 60 paid staff in Cochrane Central Executive London UK

• no central funding for reviews

• Mission

• provide up to date evidence on the effects of health care

• Name

• after Archie Cochrane, British epidemiologist

• Web address

• www.cochrane.org

• Products

• High quality systematic reviews of healthcare interventions

• Collated in the Cochrane Library, Impact Factor 6.2

http://www.cochrane.org/


• International network, not for profit, collaborative

• Infrastructure and rules

• Aims for high quality evidence and transparency

• Established methodology

• Tool for disseminating reviews: The Cochrane Library

• Registry for primary studies: CENTRAL

• Applicable knowledge useful to stakeholders

• Non-exclusive: everybody with the necessary skills can contribute

• Contribute to work attractiveness and professional pride

What is the Cochrane Collaboration?


• Contact with users in the insurance setting

• Advocates for IM research and systematic reviews to be

integrated in IM decisions and judgements, showing gaps and

possible bridges

• Identifies and tags Cochrane reviews related to IM

• Lobbies for the development of registries for IM evidence

• Provides education to IM practitioners, and other stakeholders

about evidence-based insurance medicine and Cochrane

reviews and how to use them in practice

What is Cochrane Insurance Medicine?


Question 1: Terminology: What is a ‘review’? What a ‘systematic

review’? What is a ‘Cochrane systematic review’?


Search for aggregated evidence if available

Cochrane


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Cochrane Review Production Process

• Title registration with a review group

• Protocol

– background, search, methods

– peer-reviewed

– publication in Cochrane Library

• Review

– peer-reviewed (editors and external experts)

– according to Cochrane Handbook

– published in Cochrane Library


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Typical structure of a Cochrane Review• Title

• Background

• Methods

– Inclusion criteria

– Search

– Data Synthesis

• Results

– Description of included studies

– Risk of bias

– Effects of interventions

• comparisons

• outcome data

• pooling

– forest plot

• Discussion

• Conclusions

– implications for practice

– implications for research


Question 2: How do I find a Cochrane review ? Do I need special

access?


Most common health-related questions by insurance physicians?

Kok et al:

• Prognostic questions 39%

• Intervention questions 26%

• Etiologic or diagnostic questions 17%

Cochrane Library !

Question 2: How do I find a Cochrane review? Do I need special

access?


Question 2: How do I find a Cochrane review ? Do I need special

access?


Question 2: How do I find a Cochrane review? The Cochrane

Library


Question 3: What is the PICO in the van Vilsteren review?


Question 3: What is the PICO in the van Vilsteren review?

“In patients with disease P, does therapy I work better than

therapy C in improving outcome O”?

• Patient:

• Intervention:

• Control:

• Outcome:


Question 4: What are the key steps in a Cochrane systematic

review?

Think about the different steps, you would expect in a Cochrane

review.

It may help to refer to the short version of the van Vilsteren review

(hand-out)


Question 4: What are the key steps in a Cochrane systematic

review?

1. Well-formulated question (PICO)

2. Thorough search

3. Objective selection of studies

4. Critical assessment of the methodological quality

5. Objective data extraction

6. Summary of the data (descriptive or statistical summary)

7. Conclusions for practice and research


Question 5a): Which databases did reviewers use to search for

the studies? b) What type of studies did van Vilsteren include?

Check the databases searched by the authors?

Inclusion/exclusion criteria, with regards to the

• Type of studies

• Type of participants

• Type of interventions

• Type of outcomes

Type of studies … RCT: randomised controlled trial ?

PopulationIn- en exclusion

criteria

Intervention group

Control group

randomise

RTW yes

RTW no

RTW yes

RTW no

Blinding

http://www.programmingbasics.org/en/img/random1.gif

Question 6: What is risk of bias? Other features that determine

quality?


quality?

• Randomised trials start at high quality but downgraded when

• limitations in study design: high risk of bias

• inconsistency of results

• indirectness of evidence

• imprecision of estimates (wide confidence intervals)

• publication bias


quality?

• Randomised trials start at high quality but downgraded when

• limitations in study design: high risk of bias

• inconsistency of results

• indirectness of evidence

• imprecision of the estimate (wide confidence intervals)

• publication bias



quality?

Imprecision of the estimate

Question 7: How did the reviewers define “overall quality of the

evidence”

Overall judgement of quality of evidence of all studies in a systematic review:

high, moderate, low or very low

Description Definition

High quality Further research is very unlikely to change our confidence in the estimate of effect.

Moderate quality Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

Low quality Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

Very low quality Any estimate of effect is very uncertain.

Question 8: How do I read and understand a forest plot?

see figure 3


Question 9: What is your conclusion from the evidence of this

Cochrane systematic review?


Want to know more about ‘How to read a Cochrane systematic

review?’


Thank you!

Please visit our website

http://insuremed.cochrane.org/

How to read a Cochrane review. The Basics. - EUMASS · 2019-03-27 · How to read a Cochrane...

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