Cochrane Evidence Aid for Catastrophes like Haiti’s Earthquake. “Helping by doing what we do best”

24 01 2010

How it started [1]
2005. December 26th. Someone* working for the Cochrane Collaboration was on the Internet when he accidentally saw the AOL’s home page mentioning a powerful earthquake in the Indian Ocean, triggering a powerful tsunami that swept the coasts of neighboring countries. The story and the horror unfolded over the next hours and days. From the first reports of a few thousand dead to, within a day, a few thousand dead and tens of thousands missing in one part of Indonesia alone.

“What can we do?” he thought “Aid needs evidence on what works and what doesn’t work. It is no good and, worse, might be harmful, to deliver health care that is ineffective. The Cochrane Library already contains several reviews of relevance. There are Cochrane reviews on overcoming the effects of dehydration and the treatment of injuries, both physical and psychological. Those of us who work in the production of evidence can, therefore, deliver our own form of aid: information. The provision of reliable information on the effects of health care is the way that many of us can contribute to alleviating its effects. We need to recognize the privileged position that we are in: we can help by doing what we do best.”[1]

As reader of this blog, you probably know that the Cochrane Collaboration (http://www.cochrane.org/) is an international not-for-profit and independent organization, dedicated to making up-to-date, accurate information about the effects of healthcare readily available worldwide. It produces and disseminates systematic reviews of healthcare interventions  in the Cochrane Library, which is available through subscription. The information on which these are based is drawn together collaboratively by a global network of dedicated volunteers, supported by a small staff.

Evidence Aid: what it is and what it does. [2, 3, 4, 5]
That Christmas, the idea was born to set up “Evidence Aid”.
A working party was established early January 2005 of people in the region and elsewhere.  Emails were send to people from the affected countries to express sympathy and support, and to ask for suggestions on how The Cochrane Collaboration might help.

Then, a list of over 200 interventions relevant to health care in the aftermath of the tsunami was made in consultation with all Cochrane entities, Cochrane members from affected countries, and members of other agencies such as the World Health Organization, Oxfam (one of the main UK charities working in the region), and the publishers of BMJ’s Clinical Evidence (http://clinicalevidence.com).

A prioritization was made, and subsequently lists were made of topics for which up-to-date Cochrane reviews were available and lists for which reviews were not yet available (see updated lists of  available and not currently available topics).

Concise summaries of evidence on the priority topics were offered in one place with “one-click” access to all contents, available free of charge (http://www.cochrane.org/docs/tsunamiresp​onse, now changed into http://www.cochrane.org/evidenceaid/index.htm)

The summaries link to the full evidence, which is already available on the Cochrane Library. If a summary is not currently available but there is a relevant Cochrane review in the Cochrane Library, a link takes people straight to that review. If a suitable Cochrane review is not available, links are included to other identified sources of evidence, in particular, to topics in Clinical Evidence .

In addition The Cochrane Library (http://www.thecochranelibrary.org) was made freely available in the effected countries for a six-month period. (This was before the Cochrane Library became freely available in India through funding)

Evidence matters, an example [4,5,6]
One helpful Cochrane Review was the Cochrane systematic review on the effects of brief “debriefing” [6], which is a procedure aimed to reduce immediate psychological distress and to prevent the subsequent development of psychological disorders, notably Post Traumatic Stress Disorder (PTSD). The review shows that this strategy is unlikely to be helpful and may even be harmful and cause an increase in PTSD.
After the tsunami, many teams of well-meaning people rushed to one of the worst hit areas in India, offering brief debriefing to survivors in each village, and then rushing on to the next of the 93 tsunami-affected villages in the district. Prathap Tharyan, Professor of Psychiatry and Coordinator of the South Asian Cochrane Network, found the relevant Cochrane review on debriefing and urged that this type of single session debriefing should not be provided. This message was incorporated into the content of counselor training workshops, along with evidence for interventions supported by the results of systematic reviews and other high quality research.[5]

Evidence Aid for Haiti [7]
After the tsunami it was decided to continue with Evidence Aid in natural disasters and other healthcare emergencies, drawing on knowledge gathered.

Tweets of @cochranecollab about various Evidence Aid Reviews for Haiti

Following the devastating earthquake in Haiti, The Cochrane Collaboration is working with colleagues in the World Health Organization (WHO), Pan American Health Organization (PAHO), the Centre for Reviews & Dissemination (UK), Cochrane Review Groups and others to identify Cochrane reviews and other systematic reviews of immediate importance. These, along with available Evidence Update summaries, were made available in a special Evidence Aid collection on Cochrane.org on 15 January, and have been shared with WHO and PAHO.

The information has been translated into French (thanks to the Cochrane Francophone Network) and Spanish (thanks to the Iberoamerican Cochrane Centre). At the moment, the collection includes reviews from several Cochrane Review Groups, including the Bone, Joint and Muscle Trauma Group; Depression, Anxiety and Neurosis Group; Infectious Diseases Group; Injuries Group; Renal Group and Wounds Group. [7]

Access to Evidence Aid resources for Haiti: The summaries are available at http://www.cochrane.org/evidenceaid/haiti/index.html and The Cochrane Library is freely available in the region through a variety of means. One is the Biblioteca Cochrane Plus via the Virtual Health Library BIREME interface (in English, Spanish or Portuguese).  Also, the PDF versions of all the highlighted Cochrane reviews are now available free to all on The Cochrane Library website.[7]

Is this enough?[4]
A PLOS article on Evidence Aids in 2005 already concluded: “No, not nearly enough”.[4]

Not all topics on the list have been covered by an up-to-date, good-quality systematic review. And, similar as in 2005, not all reviews have conclusions that can guide practice, because of a lack of relevant good-quality studies. After all, reviews are only as good as the studies they review. Therefore it is important to fill the gaps with good quality reviews and new practical trials on the most urgent topics.
Although things have certainly changed, i.e. more topics are now covered, there still remains room for further improvement.

If you would like to suggest additional material not yet covered, please contact Mike Clarke (mclarke@cochrane.ac.uk). You can also contribute to Evidence aid in other ways.

* This person signed the Gem [1] with “Insider”. It is not difficult to gather that the Insider is Mike Clarke, professor of clinical epidemiology at the University of Oxford, director of the UK Cochrane Centre and convenor of the working group which has set up the initiative.

Afterword: Last Monday, tweets mentioning Cochrane Evidence Aid topics appeared in my twitterstream (see Fig). As I was not profoundly familiar with this initiative, I wanted to gain more knowledge about it and summarize my findings in a post. I’m thankful to Mike Clarke and Nick Royle for instantly responding to my request for more information and Mike in particular for sending me the draft he compiled for CC-info [7] and an older cochrane gem [1], that explained how Evidence Aid arose.
Disclaimer: I’m employed as a Trial Search Coordinator of the Dutch Cochrane Centre for one day per week. The opinions expressed at this blog, however, are my own.

References:

  1. Cochrane Gem for week commencing 4 January 2005, written by “Insider”. Gems are weekly highlights one of new reviews or sometimes important news. Gems are available at the CKS database here.
  2. http://news.cochrane.org/view/item/review_one.jsp?j=177 assessed 24-01-2010
  3. Lynn Eaton (2005) Evidence based research for coping in emergencies goes online BMJ 330(7497):926 (23 April), doi:10.1136/bmj.330.7497.926-a
  4. Tharyan P, Clarke M, Green S (2005) How the Cochrane Collaboration Is Responding to the Asian Tsunami. PLoS Med 2(6): e169. doi:10.1371/journal.pmed.0020169
  5. World Health Organization (2005) Three months after the Indian Ocean earthquake-tsunami: Health consequences and WHO’s response. Available: http://www.who.int/hac/crises/internatio​nal/asia_tsunami/3months/en/index.html . Accessed 24-01-2010.
  6. Rose SC, Bisson J, Churchill R, Wessely S. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD000560. DOI: 10.1002/14651858.CD000560. Edited (no change to conclusions), published in Issue 1, 2009.
  7. Draft written for CC-INFO (January 21, 2010) by Mike Clarke. It will become available at the CC-info archive.
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When more is less: Truncation, Stemming and Pluralization in the Cochrane Library

5 01 2010

I’m on two mail lists of the Cochrane Collaboration, one is the TSC -list (TSC=Trials Search Coordinator) and the other the IRMG-list. IMRG stands for Information Retrieval Methods Group (of the Cochrane). Sometimes, difficult search problems are posted on the list. It is challenging to try to find the solutions. I can’t remember that a solution was not found.

A while ago a member of the list was puzzled why he got the following retrieval result from the Cochrane Library:

ID Search Hits
#1 (breast near tumour* ) ….. 254
#2 (breast near tumour) …… 640
#3 (breast near tumor*) ….. 428
#4 (breast near tumor) …… 640

where near = adjacent (thus breast should be just before tumour) and the asterisk * is the truncation symbol.  At the end of the word an asterisk is used for all terms that begin with that basic word root. Thus tumour* should find: tumours and tumour and thus broaden the search.

The results are odd, because #2 (without truncation) gives more hits than #1 (with truncation), and the same is true for #4 versus #3. One would expect truncation to give more results. What could be the reason behind it?

I suspected the problem had to do with the truncation. I searched for breast and tumour with or without truncation (#1 to #4) and only tumour* gave odd results: tumour* gave much less results than tumour. (to exclude that it had to do with the fields being searched I only searched the fields ti (title), ab (abstract) and kw (keywords))

Records found with tumour, not with tumour*, contained the word tumor (not shown). Thus tumour automatically searches for tumor (and vice versa). This process is called stemming.

According to the Help-function of the Cochrane Library:

Stemming: The stemming feature within the search allows words with small spelling variants to be matched. The term tumor will also match tumour.

In addition, as I realized later, the Cochrane has pluralization and singularization features.

Pluralization and singularization matches Pluralized forms of words also match singular versions, and vice versa. The term drugs will find both drug and drugs. To match either just the singular or plural form of a terms, use an exact match search and include the word in quotation marks.

Indeed (tumor* OR tumour*) (or shortly tumo*r*) retrieves a little more than tumor OR tumour: words like tumoral, tumorous, tumorectomy. Not particularly useful, although it might not be disadvantagous when used adjacent to breast, as this will filter most noise.

tumor spelling variants searched in the title (ti) only: it doesn't matter how you spell tumor (#8, #9, #10,#11), as long as you don't truncate (while using a single variant)

Thus stemming, pluralization and singularization only work without truncation. In case of truncation you should add the spelling variants yourselves if case stemming/pluralization takes place. This is useful if you’re interested in other word variants that are not automatically accounted for.

Put it another way: knowing that stemming and pluralization takes place you can simply search for the single or plural form, American or English spelling. So breast near tumor (or simply breast tumor) would have been o.k. This is the reason why these features were introduced in the first way. ;)

By the way, truncation and stemming (but not pluralization) are also features in PubMed. And this can give similar and other problems. But this will be dealt with in another blogpost.

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#CECEM David Tovey -the Cochrane Library’s First Editor in Chief

13 06 2009

cochrane-symbolThis week I was attending another congress, the Continental European Cochrane Entities Meeting (CECEM).

This annual meeting is meant for staff from Cochrane Entities, thus Centre Staff, RGC’s (Review Group Coordinators), TSC’s (Trial Search Coordinators) and other staff members of the Cochrane Collaboration based in Continental Europe.

CECEM 2009 was held in Maastricht, the beautiful old Roman city in the South of the Netherlands. The city where my father was born and where I spend many holidays.

One interesting presentation was by Cochranes’ 1st Editor in chief, David Tovey, previously GP in an urban practice in London for 14 years and  Editorial Director of the BMJ Group’s ‘Knowledge’ division (responsible for BMJ Clinical Evidence and its sister product Best Treatments, see announcement in Medical News Today)

David began with saying that the end user is really the key person and that the impact of the Cochrane Reviews is most important.

“How is it that a Senior health manager in the UK may shrug his shoulders when you ask him if he has ever heard of Cochrane?”

“How do we make sure that our work had impact? Should we make use of user generated content?”

Quality is central, but quality depends on four pillars. Cochrane reviews should be reliable, timely, relevant and accessible.

Cochrane Tovey wit

How quality is perceived is dependent on the end users. There are several kinds of end users, each with his own priorities.

  1. doctor: wants comprehensive and up-to-date info, wants to understand and get answers quickly.
  2. patient: trustworthiness, up-to-date, wants to be able to make sense of it.
  3. scientist: wants to see how the conclusions are derived.
  4. policy and guideline-makers.

Reliable: Several articles have shown Cochrane Systematic Reviews to be more reliable then other systematic reviews  (Moher, PLOS BMJ)*

Timely: First it takes time to submit a title of a Cochrane Review and then it takes at least 2 years before a protocol becomes a review. Some reviews take even longer than 2 years. So there is room for improvement.

Patients are also very important as end user. Strikingly, the systematic review about the use of cranberry to prevent recurrent urinary tract infection is the most frequently viewed article,- and this is not because the doctors are most interested in this particular treatment….

Doctors: Doctors often rely on their colleagues for a quick and trustworthy answer. Challenge: “can we make consulting the Cochrane Library as easy as asking a colleague: thus timely and easy?”

Solutions?

  • making plain language summaries more understandable
  • Summary of Findings
  • podcasts of systematic reviews (very successful till now), .e. see an earlier post.
  • Web 2.0 innovations

Key challenges:

  • ensure and develop consistent quality
  • (timely) updating
  • putting the customer first: applicability & prioritization
  • web delivery
  • resources (not every group has the same resources)
  • make clear what an update means and how important this update is: are there new studies found? are these likely to change conclusions or not? When was the last amendment to the search?

I found the presentation very interesting. What I also liked is that David stayed with us for two days -also during the social program- and was easy approachable. I support the idea of a user-centric approach very much. However, I had expected the emphasis to be less on the timeliness (of updates for instance), but more on how users (patients, doctors) can get more involved and how we review the subjects that are most urgently needed. Indeed, when I twittered that Tovey suggested that we “make consulting the Cochrane Library as easy as asking a colleague”, Jon Brassey of TRIP answered that a lot has to be done to fulfill this, as the Cochrane only answers 2 out of 350+ questions asked by GPs in the UK, a statement that appeared to be based on his own experience (Jon is founder of the TRIP-database).

But in principle I think that Jon is correct. Right now too few questions (in the field of interventions) are directly answered by Cochrane Systematic Reviews and too little is done to reach and involve the Cochrane Library users.

13-6-2009 15-43-17 twitter CECEM discussion

click to enlarge

During the CECEM other speakers addressed some of these issues in more detail. André Knottnerus, Chair of the Dutch Health Council, discussed “the impact of Cochrane Reviews”, and Rob the Bie of the Rehabilitation & Related Therapies field discussed “Bridging the  gap between evidenced based practice and practice based evidence”, while Dave Brooker launched ideas about how to implement Web 2.0 tools. I hope to summarize these (and other) presentations in a blogpost later on.

*have to look this up

NOTE (2009-11-10).

I had forgotten about this blank “citation” till this post was cited quite in another context (see comment: http://e-patients.net/archives/2009/11/tell-the-fda-the-whole-story-please.html) and someone commented that the asterisk to the “the amazing statement” had still to be looked up,  indirectly arguing that this statement thus was not reliable- and continuing by giving an example of a typically flawed Cochrane Review that hit the headlines 4 years ago, a typical exception to the rule that “Cochrane systematic reviews are more reliable than other systematic reviews”. Of course when it is said that A is more trustworthy than B it is meant on average. I’m a searcher, and on average the Cochrane searchers are excellent, but when I do my best I surely can find some that are not good at all. Without doubt that also pertains to other parts of Cochrane Systematic Reviews.
In addition -and that was the topic of the presentation- there is room for improvement.

Now about the asterisk, which according to Susannah should have been (YIKES!) 100 times bigger. This was a post based on a live presentation and I couldn’t pick up all the references on the slides while making notes. I had hoped that David Tovey would have made his ppt public, so I could have checked the references he gave. But he didn’t and so I forgot about it. Now I’ve looked some references up, and, although they might not be identical to the references that David mentioned, they are in line with what he said:

  1. Moher D, Tetzlaff J, Tricco AC, Sampson M, Altman DG, 2007. Epidemiology and Reporting Characteristics of Systematic Reviews. PLoS Med 4(3): e78. doi:10.1371/journal.pmed.0040078 (free full text)
  2. The PLoS Medicine Editors 2007 Many Reviews Are Systematic but Some Are More Transparent and Completely Reported than Others. PLoS Med 4(3): e147. doi:10.1371/journal.pmed.0040147 (free full text; editorial coment on [1]
  3. Tricco AC, Tetzlaff J, Pham B, Brehaut J, Moher D, 2009. Non-Cochrane vs. Cochrane reviews were twice as likely to have positive conclusion statements: cross-sectional study. J Clin Epidemiol. Apr;62(4):380-386.e1. Epub 2009 Jan 6. [PubMed -citation]
  4. Anders W Jørgensen, Jørgen Hilden, Peter C Gøtzsche, 2006. Cochrane reviews compared with industry supported meta-analyses and other meta-analyses of the same drugs: systematic review BMJ  2006;333:782, doi: 10.1136/bmj.38973.444699.0B (free full text)
  5. Alejandro R Jadad, Michael Moher, George P Browman, Lynda Booker, Christopher Sigouin, Mario Fuentes, Robert Stevens (2000) Systematic reviews and meta-analyses on treatment of asthma: critical evaluation BMJ 2000;320:537-540, doi: 10.1136/bmj.320.7234.537 (free full text)

In previous posts I regularly discussed that (Merck’s Ghostwriters, Haunted Papers and Fake Elsevier Journals and One Third of the Clinical Cancer Studies Report Conflict of Interest) that pharma-sponsored trials rarely produce results that are unfavorable to the companies’ products [e.g. see here for an overview, and many papers of Lisa Bero].

Also pertinent to the abovementioned discussion at E-patient-Net is my earlier post: The Trouble with Wikipedia as a Source for Medical Information. (references still not in the correct order. Yikes!)

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Another Search Bug? Now in the Cochrane Library!

16 10 2008

It seems that I’m becoming an expert in search problems and bugs.
Partly because I search a lot, but also because my colleagues and I often share our search problems.

This time, while giving a class, Hanny and Heleen noticed that (a) combining two terms in the Cochrane Library Search Bar with ‘and’ gives less hits than when you (b) search for those terms individually and combine them in the History with ‘and’ (see Figures). This is odd, because it should not make any difference whether you look these words up individually (which takes more time) or combine them directly. The field in which both these terms should occur is in the title, abstract and/or keyword field.
(c) Searching via advanced search has the same effect as searching the terms separately in the search bar (#7, #9)

The 3 search modes (click to enlarge)

Two examples are given below: (1) obesity and sibutramine (sets #1-#9) and (2) sibutramine and body weight (#10-#14).
Both obesity and body weight are MeSH (key words from MEDLINE).

Search History showing results two examples (click on Figure to enlarge)

It is unclear why certain records can’t be found when combining them in the search bar. The order doesn’t matter, for instance. It might have something to do with certain keywords not being found when the keyword command is not directly next to term sought (set #12 in Search History, and figure below).

Anyway this is highly undesirable. Especially for the beginner, who just wants to find a cochrane systematic review by doing a quick search. Hopefully this ‘bug’ will be fixed soon, because important papers might be missed (see below).

Missed papers (have one of the terms exclusively in the keyword (MeSH)section





Wiley Interscience downtime

24 06 2008

News from Wiley:

The Cochrane Library will be inaccessible during June 28-29.

This is because Wiley Interscience will be unavailable during June 28-29, as all journal content from Blackwell Synergy is merged onto Wiley Interscience. All other platforms (e.g. Ovid) will be unaffected.

——-NL flag NL vlag

Nieuws van Wiley:

De Cochrane Library is 28-29 juni niet toegankelijk.

Tijdschriften van Blackwell Synergy gaan dan op in Wiley Interscience. Wiley is daarmee ook niet toegankelijk, met uitzondering van systemen die op OVID draaien.





Cochrane Library: saved searches (2) … and recent changes

5 05 2008

The previously reported problem with accessing saved searches on the Cochrane Library has been fixed (as off April 23th). Users should now be able to run all of their saved searches.

Hopefully the often encountered problems with the saved searche feature are now resolved once and for all. Indeed continued access to these searches is critical to Trial Search Coordinators and other users frequently running (or editing) saved searches.

Also, with the Issue 2, 2008 load, there were changes in the status indicators (“Update”, “Commented”, “Withdrawn”) used on the Cochrane Library. E.g. The ‘Update’ flag no longer exists and instead has been replaced with the more accurate flags ‘New search’ ‘Conclusions changed’ and ‘Major change’.
The specifics of these changes are posted on the Issue change notice at this PDF.

**********************************************8

Het eerder gemelde probleem met het aanpassen en uitvoeren van “opgeslagen searches” in de Cochrane Library is verholpen (vanaf 23 april). Alle opgeslagen zoekacties kunnen nu weer uitgevoerd en aangepast worden.

Hopelijk zijn nu de “saved search”-problemen de wereld uit, want het afgelopen deden zich frequent problemen voor. Dit is bijzonder vervelend, vooral voor de Trial Search Coordinators en andere gebruikers die frequent searches updaten/uitvoeren.

Ook vermeldenswaardig: bij de 2e upload dit jaar (de Cochrane Library wordt 4x per jaar “ververst”) zijn de status indicators van de Cochrane Reviews (“Update”, “Commented”, “Withdrawn”) gewijzigd. Zie verder deze PDF.





No editing of Saved Searches in the Cochrane Library the next 24 hours!

22 04 2008

The last few weeks there have been errors in running saved searches in the Cochrane Library.

Since engineers will introduce some changes to the Cochrane Library, users are discouraged to edit or save existing searching over the next 24 hours.

Hopefully the problems will be resolved by then.

Notice at the home page of the Cochrane Library:








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