An introduction to systematic reviews and meta-analysis: A workshop report on promoting evidence based medical practice through capacity building in research synthesis

The increasing urgency for evidence based practice, especially in resource limited settings has inspired many initiatives to this effect. In Africa there is limited skill in research synthesis and the production of systematic reviews. The Centre for the Development of Best Practices in Health, together with the South African Cochrane Centre organised a workshop to train Cameroonian researchers on how to initiate and complete systematic reviews. Five facilitators and fifteen participants met over a period of four days. At the end of the workshop the participants expressed high levels of satisfaction and motivation to conduct systematic reviews, but expressed the need for additional support. Facilitators of future systematic review courses should address challenges related to internet access, adult education and realistic expectations from the participants.Key words: Systematic reviews, meta-analysis, workshop, capacity building, Cameroo

Cochrane Qualitative and Implementation Methods Group guidance paper 6:Methods for question formulation, searching, and protocol development for qualitative evidence synthesis

This paper updates previous Cochrane guidance on question formulation, searching, and protocol development, reflecting recent developments in methods for conducting qualitative evidence syntheses to inform Cochrane intervention reviews. Examples are used to illustrate how decisions about boundaries for a review are formed via an iterative process of constructing lines of inquiry and mapping the available information to ascertain whether evidence exists to answer questions related to effectiveness, implementation, feasibility, appropriateness, economic evidence, and equity. The process of question formulation allows reviewers to situate the topic in relation to how it informs and explains effectiveness, using the criterion of meaningfulness, appropriateness, feasibility, and implementation. Questions related to complex questions and interventions can be structured by drawing on an increasingly wide range of question frameworks. Logic models and theoretical frameworks are useful tools for conceptually mapping the literature to illustrate the complexity of the phenomenon of interest. Furthermore, protocol development may require iterative question formulation and searching. Consequently, the final protocol may function as a guide rather than a prescriptive route map, particularly in qualitative reviews that ask more exploratory and open-ended questions

Identification of ‘Candidatus Phytoplasma’ species in “huanglongbing” infected citrus orchards in the Caribbean

“Huanglongbing” (HLB) is one of the most devastating diseases of citrus orchards worldwide. Samples from 183 citrus plants of different cultivars and rootstock/cultivar combinations, showing HLB symptoms in three Caribbean countries (Cuba, Jamaica, and Guadeloupe-France), were collected to verify the possible co-infection of ‘Candidatus Phytoplasma’ and ‘Candidatus Liberibacter’ species. The 64% of the samples resulted positive to the ‘Ca. L. asiaticus’ and the 27% to diverse ‘Ca. Phytoplasma’-related species, moreover about the 14% of the samples infected with ‘Ca. Liberibacter’ were also found positive to phytoplasmas, indicating the presence of mixed infection especially in the orchards located in Cuba. Moreover, in one of the samples from Jamaica mixed phytoplasma infection was detected. Moreover the detection of only phytoplasmas in 11 symptomatic citrus samples collected from Cuba and Guadeloupe without ‘Ca. Liberibacter’ detection, confirmed that the symptomatology cannot be the sole criterium to discriminate between the presence of the two pathogens, and molecular detection is necessary to identify single or mixed infections. Diaphorina citri insects collected from Cuba and Guadeloupe resulted infected with ‘Ca. L. asiaticus’ confirming its active role in the dissemination of the pathogen. Only one insect of the Cicadidae family, collected in Guadeloupe, was found positive for phytoplasma presence. Considering that the phytoplasmas belonging to some ‘Candidatus species’ were detected in the three countries in different citrus varieties, a relevant role as phytoplasma reservoir can be attribute to citrus orchards

Evidence briefs and deliberative dialogues : perceptions and intentions to act on what was learnt

Includes abstracts in French, Spanish, Arabic, Chinese, and RussianEvidence briefs and deliberative dialogues aimed at policy-makers and stakeholders appear to be useful, highly regarded, and lead to intentions to act. The present study is an early attempt to develop better understanding about these relatively new strategies to support the use of research evidence in policymaking. Respondents to the survey generally reported strong intentions to act on what they had learned from evidence briefs. Overall, “not concluding with recommendations” and “not aiming for a consensus” were identified as the least helpful features of briefs and dialogues, respectively

Cochrane Qualitative and Implementation Methods Group Guidance paper 2: Methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings

The Cochrane Qualitative and Implementation Methods Group develop and publish guidance on the synthesis of qualitative and mixed-method implementation evidence. Choice of appropriate methodologies, methods and tools is essential when developing a rigorous protocol and conducting the synthesis. Cochrane authors who conduct qualitative evidence syntheses have thus far used a small number of relatively simple methods to address similarly written questions. Cochrane has invested in methodological work to develop new tools and to encourage the production of exemplar reviews to show the value of more innovative methods that address a wider range of questions. In this paper in the series we report updated guidance on the selection of tools to assess methodological limitations in qualitative studies, and methods to extract and synthesise qualitative evidence. We recommend application of GRADE-CERQual to assess confidence in qualitative synthesised findings. This guidance aims to support review authors to undertake a qualitative evidence synthesis that is intended to be integrated subsequently with the findings of one or more Cochrane reviews of the effects of similar interventions. The review of intervention effects may be undertaken concurrently with or separate to the qualitative evidence synthesis. We encourage further development through reflection and formal testing

Cochrane Qualitative and Implementation Methods Group Guidance Paper 5: Reporting guidelines for qualitative, implementation and process evaluation evidence syntheses

OBJECTIVE: To outline contemporary and novel developments for presentation and reporting of syntheses of qualitative, implementation and process evaluation evidence, and provide recommendations for use of reporting guidelines. STUDY DESIGN AND SETTING: An overview of reporting guidelines for qualitative, implementation and process evaluation evidence syntheses drawing on current international literature and the collective expert knowledge of the Cochrane Qualitative and Implementation Methods Group. RESULTS AND CONCLUSION: Several reporting guidelines exist that can be used or adapted to report syntheses of qualitative, implementation and process evaluation evidence. Methods to develop individual guidance varied. The use of a relevant reporting guideline can enhance the transparency, consistency and quality of reporting. Guidelines exist that are: generic; method specific; and for particular aspects of the reviewing process eg searching. Caution is expressed over the potential for reporting guidelines to produce a mechanistic approach moving the focus away from the content and towards the procedural aspects of the review. The use of a reporting guideline is recommended and a five-step decision flowchart to guide the choice of reporting guideline is provided. Gaps remain in method specific reporting guidelines such as mixed-study, implementation and process evaluation evidence syntheses

Cochrane Qualitative and Implementation Methods Group Guidance Paper 5: Reporting guidelines for qualitative, implementation and process evaluation evidence syntheses

OBJECTIVE: To outline contemporary and novel developments for presentation and reporting of syntheses of qualitative, implementation and process evaluation evidence, and provide recommendations for use of reporting guidelines. STUDY DESIGN AND SETTING: An overview of reporting guidelines for qualitative, implementation and process evaluation evidence syntheses drawing on current international literature and the collective expert knowledge of the Cochrane Qualitative and Implementation Methods Group. RESULTS AND CONCLUSION: Several reporting guidelines exist that can be used or adapted to report syntheses of qualitative, implementation and process evaluation evidence. Methods to develop individual guidance varied. The use of a relevant reporting guideline can enhance the transparency, consistency and quality of reporting. Guidelines exist that are: generic; method specific; and for particular aspects of the reviewing process eg searching. Caution is expressed over the potential for reporting guidelines to produce a mechanistic approach moving the focus away from the content and towards the procedural aspects of the review. The use of a reporting guideline is recommended and a five-step decision flowchart to guide the choice of reporting guideline is provided. Gaps remain in method specific reporting guidelines such as mixed-study, implementation and process evaluation evidence syntheses

Cochrane Qualitative and Implementation Methods Group Guidance Series - paper 1: Introduction

Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognized health c are resources for use in a decision-making process. 1 Cochrane works collaboratively with contributors around the world to produce authoritative, relevant, and reliable reviews. Coch rane reviews are commonly used in a guideline development process to determine recommendations fo r practice. The Cochrane Qualitative and Implementation Methods Group provide methodolog ical advice and guidance to Cochrane as well as leading methodological developm ent to benefit the wider qualitative evidence synthesis community. In this introductory paper 1 we briefly outline the evolution of qualitative and mixed-method synthesis methods, the role of qualitative and mixed- method syntheses in a decision-making process, and the contribution of qualitative and mixed-method syntheses to understanding complexity in complex intervention reviews. We then introduce a series of papers that provide Coch rane guidance on conducting qualitative and mixed-method evidence syntheses for a decision- making context

Cochrane Qualitative and Implementation Methods Group Guidance paper 2: Methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings

The Cochrane Qualitative and Implementation Methods Group develop and publish guidance on the synthesis of qualitative and mixed-method implementation evidence. Choice of appropriate methodologies, methods and tools is essential when developing a rigorous protocol and conducting the synthesis. Cochrane authors who conduct qualitative evidence syntheses have thus far used a small number of relatively simple methods to address similarly written questions. Cochrane has invested in methodological work to develop new tools and to encourage the production of exemplar reviews to show the value of more innovative methods that address a wider range of questions. In this paper in the series we report updated guidance on the selection of tools to assess methodological limitations in qualitative studies, and methods to extract and synthesise qualitative evidence. We recommend application of GRADE-CERQual to assess confidence in qualitative synthesised findings. This guidance aims to support review authors to undertake a qualitative evidence synthesis that is intended to be integrated subsequently with the findings of one or more Cochrane reviews of the effects of similar interventions. The review of intervention effects may be undertaken concurrently with or separate to the qualitative evidence synthesis. We encourage further development through reflection and formal testing

Setting priorities for knowledge translation of Cochrane reviews for health equity: Evidence for Equity

Background A focus on equity in health can be seen in many global development goals and reports, research and international declarations. With the development of a relevant framework and methods, the Campbell and Cochrane Equity Methods Group has encouraged the application of an ‘equity lens’ to systematic reviews, and many organizations publish reviews intended to address health equity. The purpose of the Evidence for Equity (E4E) project was to conduct a priority-setting exercise and apply an equity lens by developing a knowledge translation product comprising summaries of systematic reviews from the Cochrane Library. E4E translates evidence from systematic reviews into ‘friendly front end’ summaries for policy makers. Methods The following topic areas with high burdens of disease globally, were selected for the pilot: diabetes/obesity, HIV/AIDS, malaria, nutrition, and mental health/depression. For each topic area, a “stakeholder panel” was assembled that included policymakers and researchers. A systematic search of Cochrane reviews was conducted for each area to identify equity-relevant interventions with a meaningful impact. Panel chairs developed a rating sheet which was used by all panels to rank the importance of these interventions by: 1) Ease of Implementation; 2) Health System Requirements; 3)Universality/Generalizability/Share of Burden; and 4) Impact on Inequities/Effect on equity. The ratings of panel members were averaged for each intervention and criterion, and interventions were ordered according to the average overall ratings. Results Stakeholder panels identified the top 10 interventions from their respective topic areas. The evidence on these interventions is being summarized with an equity focus and the results posted online, at http://methods.cochrane.org/equity/e4e-series. Conclusions This method provides an explicit approach to setting priorities by systematic review groups and funders for providing decision makers with evidence for the most important equity-relevant interventions