Now let's move on to our next session. We're going to talk about producers and users of systematic reviews. Who is doing systematic reviews? More than 60% of the systematic reviews are done by independent authors, independent investigators, researches, clinicians, who are interested in a particular topic. And the Cochrane Collaboration produces less that 40% of the systematic reviews, and it's the largest international organization that does systematic reviews. They're also grouped interested in policy. For example, the professional societies, governments payers. They usually can't check out their systematic reviews. For example, in the United States, the Agency for Healthcare and Research and Quality Evidence-based Practice Centers. They do a lot of systematic reviews in the U.S. In the U.K. the National Institute for Health and Care Excellence, the NIHCE. They sponsor a lot of systematic reviews to support their practice guidelines. And similarly, there are institutes in Germany, and other countries, that do systematic reviews. Business does systematic reviews, too. For example, Hayes and ECRI are the two companies that have a lot of contract from the pharmaceutical companies on systematic reviews. Who are using systematic reviews? Well, all types of decision makers. There could be individual doctors and the researchers, patients and consumers, guidelines producers. Policy makers, for example, purchasers, payers, and regulatory authorities. You may have seen the pyramid of the level of evidence. On top of the pyramid is systematic reviews. And for clinical questions on the intervention effectiveness, systematic reviews of randomized control trials are usually regarded as the highest level of evidence. And why is that? Here are the features of a systematic review. A systematic review facilitates efficient integration of information for rational decision making. It provides a clear and transparent process, and that process is documented in the protocol of your systematic review. It helps to demonstrate where the effects of healthcare are consistent, and where they vary. Again, that relates back to the idea of whether the effect size are homogeneous or heterogeneous. Because you're using a transparent and clear process, you minimize the bias and systematic errors in summarizing evidence. Meta-analysis can provide more precise estimates than individual studies. And systematic reviews can be readily updated as needed with new information, new evidence, coming to the literature. And they allow decisions based on the totality of the available evidence. Having said a lot about what systematic review and meta-analysis are. And here are some useful references, of recommended readings for you, to learn about how to do it. The first book is the Finding What Works in Health Care. It's put together by the Institute of Medicine. And they outline the standards for doing systematic reviews. And this book is freely available online. And you can Google the book name and you will find it. Another useful reference is the Cochrane Handbook for Systematic Reviews of Interventions. Again, this book is freely available online. And it's the handbook used by the Cochrane Review authors and recommended by the Cochrane Collaboration. Cochrane is a global independent network of researchers, professionals, patients, caregivers and people interested in healthcare. And the Cochrane collaboration produces systematic reviews. As I said, it's the largest organization, international organization, that produces systematic reviews. And they study all of the best available evidence generated through research, and make it easier to inform decisions about health. It is a not for profit organization with collaborations from more than 120 countries. Working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. So if you Google Cochrane and it will take you to the Cochrane Collaboration's home page. You may have recognized already that the Cochrane collaboration's logo looks like a forest plot. Which we talked about early on that a meta analysis is typically showing a forest plot. The circle formed by two C shapes represents our global collaboration. And then in the center of the circle, you see a forest plot. This forest plot when in our logo illustrates an example of the potential for systematic reviews. To improve health care and it shows that corticosteroids given to women who are about to give birth prematurely, can save the life of the new born child. So this is one of our early systematic reviews and was influential in increasing the use of this treatment. And probably this single systematic review has saved thousands of babies lives around the world. Again, the Cochrane Collaboration prepares, maintains, and promotes the accessibility of systematic reviews of the effects of healthcare interventions. There are 14 centers around the world. In the United States Cochrane Center, is one of the fourteen centers that helps to facilitate the work of the Cochrane collaboration. And U.S. Cochrane Center is located at Johns Hopkins Bloomberg School of Public Health. In the U.S. Cochrane Center's dedicated to promoting awareness of the Cochrane collaboration. And its objectives and access to the Cochrane library in the United States. The Cochrane Library is the main product of the Cochrane collaboration. It's published daily by John Wiley and it contains by issue 4 of 2015 Cochrane's systematic reviews. There are over 6,000 completed Cochrane Systematic Reviews. It also has a collection of non Cochrane Systematic Reviews, and there are over 36,000 of them. One of the most accessed of resources of the Cochrane library is the central registrar of controlled trials. And all the controlled trials gathered from medline, and these, and other databases were gathered together, and there are over 848,000 of them. And if you're browsing the Cochran Library there are many useful resources, including the reviews, the trials, editorials, and highlights. And I would encourage you to take a look and see if there are reviews answering your own research question. The key messages for today include the following. I hope you will be able to describe what is a systematic review and meta-analysis. Again, systematic review uses explicit methods to identify, select, appraise, and synthesize results from similar but separate studies. And meta-analysis refers to the statistic analysis of the results from individual studies, and is an optional component of a systematic review. The Cochrane Library is the main product of the Cochrane collaboration. And is the single best place to find independent, high quality evidence for health care decision making. Thank you for listening, we will continue our discussion, we will talk about where to start, which is how to formulate your research question. Thank you very much. [MUSIC]
