To compare the methods and findings of systematic reviews (SRs) on common tobacco control interventions from two organizations: the Cochrane Collaboration ("Cochrane") and the US Task Force for Community Preventive Services ("the Guide").
Literature review. We retrieved all reviews pertaining to tobacco control produced by the Cochrane and the Guide. We identified seven common topics and compared methods and findings of the retrieved reviews.
There was considerable variability in the designs of included studies and methods of data synthesis. On average, Cochrane identified more studies than did the Guide (Mean 43.7 vs. 19.0), with only limited overlap between sets of included studies. Most Cochrane reviews (71.4%) were synthesized narratively, whereas most Guide reviews (85.7%) were synthesized using a median of effect size. Despite these differences, findings of the reviews yielded substantial agreement.
Cochrane and the Guide conduct SRs on similar tobacco control-related topics differently. The SRs of the two organizations include overlapping, but nonidentical sets, of studies. Still, they usually reach similar conclusions. Identification of all pertinent original studies seems to be a weak point in the SR process. Policy makers should use reviews from both organizations in formulating tobacco control policy.
"Furthermore, the limited sensitivity of search strategies is shared by many, if not most, reviews: it has been pointed out that the systematic reviews of the same topic by the Cochrane Collaboration and the Task Force on Community Preventive Services differ not only in methods of synthesis of the results, but also in the number of identified studies, with an only limited overlap between sets of included studies . Indeed, our meta-review identified systematic reviews with similar objectives, covering similar periods of time that had retrieved different numbers of primary RCTs. "
[Show abstract][Hide abstract] ABSTRACT: The economic impact and ease of measurement of all-cause hospital readmission rates (HRR) have led to the current debate as to whether they are reducible, and whether they should be used as a publicly reported quality indicators of medical care.
To assess the efficacy of broad clinical interventions in preventing HRR of patients with chronic diseases
A meta-review of published systematic reviews of randomized controlled trials (RCTs) of clinical interventions that have included HRR among the patients' outcomes of interest.
Meta-analyses of RCTs have consistently found that, in the community, disease management programs significantly reduced HRR in patients with heart failure, coronary heart disease and bronchial asthma, but not in patients with stroke and in unselected patients with chronic disorders. Inhospital interventions, such as discharge planning, pharmacological consultations and multidisciplinary care, and community interventions in patients with chronic obstructive pulmonary diseases had an inconsistent effect on HRR.
Main study limitation
Despite their economic impact and ease of measurement, HRR are not the most important outcome of patient care, and efforts aimed at their reduction may compromise patients' health by reducing also justified re-admissions.
The efficacy of inhospital interventions in reducing HRR is in need of further study. In patients with heart diseases and bronchial asthma, HRR may be considered as a publicly reported quality indicator of community care, provided that future research confirms that efforts to reduce HRR do not adversely affect other patients’ outcomes, such as mortality, functional capacity and quality of life. Future research should also focus on the reasons for the higher efficacy of community interventions in patients with heart diseases and bronchial asthma than in those with other chronic diseases.
Israel Journal of Health Policy Research 01/2013; 2(1):1. DOI:10.1186/2045-4015-2-1
"Reviewing all of the evidence is rarely a feasible strategy for those developing plans. Yet, even a review of reviews in this field is challenging, especially as reviews may be of varying quality and produce conflicting results . An alternative is to draw on authoritative sources of systematic reviews, and base recommendations on interventions proposed by leading agencies. "
[Show abstract][Hide abstract] ABSTRACT: Tobacco control is an area where the translation of evidence into policy would seem to be straightforward, given the wealth of epidemiological, behavioural and other types of research available. Yet, even here challenges exist. These include information overload, concealment of key (industry-funded) evidence, contextualization, assessment of population impact, and the changing nature of the threat.
In the context of Israel's health targeting initiative, Healthy Israel 2020, we describe the steps taken to develop a comprehensive tobacco control strategy. We elaborate on the following: a) scientific issues influencing the choice of tobacco control strategies; b) organization of existing evidence of effectiveness of interventions into a manageable form, and c) consideration of relevant philosophical and political issues. We propose a framework for developing a plan and illustrate this process with a case study in Israel.
Broad consensus exists regarding the effectiveness of most interventions, but current recommendations differ in the emphasis they place on different strategies. Scientific challenges include integration of complex and sometimes conflicting information from authoritative sources, and lack of estimates of population impact of interventions. Philosophical and political challenges include the use of evidence-based versus innovative policymaking, the importance of individual versus governmental responsibility, and whether and how interventions should be prioritized.The proposed framework includes: 1) compilation of a list of potential interventions 2) modification of that list based on local needs and political constraints; 3) streamlining the list by categorizing interventions into broad groupings of related interventions; together these groupings form the basis of a comprehensive plan; and 4) refinement of the plan by comparing it to existing comprehensive plans.
Development of a comprehensive tobacco control plan is a complex endeavour, involving crucial decisions regarding intervention components. "Off the shelf" plans, which need to be adapted to local settings, are available from a variety of sources, and a multitude of individual recommendations are available. The proposed framework for adapting existing approaches to the local social and political climate may assist others planning for smoke-free societies. Additionally, this experience has implications for development of evidence-based health plans addressing other risk factors.
Health Research Policy and Systems 05/2010; 8(1):17. DOI:10.1186/1478-4505-8-17 · 1.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The systematic review (SR) lies at the core of evidence-based medicine. While it may appear that the SR provides a reliable summary of existing evidence, standards of SR conduct differ. The objective of this research was to examine systematic review (SR) methods used by the Cochrane Collaboration ("Cochrane") and the Task Force on Community Preventive Services ("the Guide") for evaluation of effectiveness of tobacco control interventions.
We searched for all reviews of tobacco control interventions published by Cochrane (4th quarter 2008) and the Guide. We recorded design rigor of included studies, data synthesis method, and setting.
About a third of the Cochrane reviews and two thirds of the Guide reviews of interventions in the community setting included uncontrolled trials. Most (74%) Cochrane reviews in the clinical setting, but few (15%) in the community setting, provided pooled estimates from RCTs. Cochrane often presented the community results narratively. The Guide did not use inferential statistical approaches to assessment of effectiveness.
Policy makers should be aware that SR methods differ, even among leading producers of SRs and among settings studied. The traditional SR approach of using pooled estimates from RCTs is employed frequently for clinical but infrequently for community-based interventions. The common lack of effect size estimates and formal tests of significance limit the contribution of some reviews to evidence-based decision making. Careful exploration of data by subgroup, and appropriate use of random effects models, may assist researchers in overcoming obstacles to pooling data.
BMC Medical Research Methodology 04/2010; 10(1):34. DOI:10.1186/1471-2288-10-34 · 2.27 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.