This is the author s version of a work that was submitted/accepted for publication in the following source: Chan, Raymond Javan (2012) Two decades of exceptional achievements : does the evidence support nurses to favour Cochrane systematic reviews over other systematic reviews? International Journal of Nursing Studies, 49(7), pp. 773-774. This file was downloaded from: http://eprints.qut.edu.au/51499/ c Copyright 2012 Elsevier This is the author s version of a work that was accepted for publication in International Journal of Nursing Studies. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in International Journal of Nursing Studies, [VOL 49, ISSUE 7, (2012)] DOI: 10.1016/j.ijnurstu.2012.05.007 Notice: Changes introduced as a result of publishing processes such as copy-editing and formatting may not be reflected in this document. For a definitive version of this work, please refer to the published source: http://dx.doi.org/10.1016/j.ijnurstu.2012.05.007
Submission Type: Guest Editorial Title: Two decades of exceptional achievements: Does the evidence support nurses to favour Cochrane systematic reviews over other systematic reviews? Authors: Raymond Javan Chan a,b,c* Andrew Wong d a Cancer Care Services, Royal Brisbane and Women s Hospital, Brisbane, Australia b School of Nursing and Midwifery, University of Queensland, Brisbane, Australia c Research Centre for Clinical and Community Practice Innovation (RCCCPI), Griffith University, Brisbane, Australia d Faculty of Science and Engineering, Queensland University of Technology, Brisbane, Australia Keywords: Cochrane Collaboration, Evidence-based healthcare, Nursing, Overview, Systematic Review
Systematic reviews (SRs) are increasingly recognised as the standard approach in summarizing health research and influence clinical nursing practice and health care decisions (Coster and Norman, 2009, Grimshaw and Russell, 1993). High quality SRs should have a clearly stated set of objectives with pre-defined eligibility criteria for studies; an explicit reproducible methodology; a systematic search that attempts to identify all studies that would meet the eligibility criteria; an assessment of the validity of the findings of the included studies; the assessment of risk of bias; and a systematic presentation and synthesis of the characteristics of findings of the included study (Higgins and Green, 2011). Although SRs are highly regarded and are expected to be rigorous, just as other research, their quality may vary (Choi et al., 2001, Hoving et al., 2001). To overcome the challenge presented by the variable quality of SRs, the American Institute of Medicine (IOM) recently published a document entitled Finding What Works in Health Care: Standards for Systematic Reviews which comprehensively discussed a range of recommendations for improving the standards of published SRs (Institute of Medicine of the National Academics, 2011). This document offered recommendations on the entire process of conducting a SR from initiating a SR to the reporting of a SR. Rather than inventing new methods, this document acknowledged the current effective resources (e.g. the PRISMA Guidelines, the CONSORT statement, and GRADE) and partnerships (e.g. the Centre for Reviews and Dissemination, the Cochrane Collaboration) to achieve the common goal of improving SR standards. Improving the
conduct and reporting of SRs is expected to have an enormous impact on healthcare outcomes internationally. Papers published in the International Journal of Nursing Studies (IJNS) over the years have demonstrated a recognition among the nursing academic community of the contribution of the Cochrane Collaboration in maintaining high standards in the conduct and reporting of systematic reviews (Chan et al., 2012, Coster and Norman, 2009, Davison et al., 2010). Over the past two decades (1993-2012), the Cochrane Collaboration has undertaken exceptional work in promoting evidence-based healthcare. The Cochrane Database of Systematic Reviews (CDSR) most recent impact factor is 6.186 (2010), which is equivalent to one of the top 10 general medicine journals (Tovey, 2011). The CDSR is searched every second, a CDSR abstract is accessed every two seconds, and a CDSR full text is accessed every three seconds (Tovey, 2011). A recent editorial by Davison and colleagues highlighted the relevance of CDSR to evidencebased nursing internationally (Davison et al., 2010). Davison et al. acknowledged that there are many high quality non-cdsr reviews in the literature. But there are also substantial concerns about potential publication bias in non-cdsr reviews, highlighting apparent differences between the results and conclusions of CDSR and non-cdsr reviews (Tricco et al., 2009). These authors also reported that non-cdsr reviews are twice as likely to draw positive conclusions compared to CDSR reviews (Tricco et al., 2009).
Nurse clinicians, other health professionals, and policy makers are facing a plethora of reviews in the literature (Bastian et al., 2010, Moher et al., 2007). For clinicians and guideline developers, there is an increased need for appraising non-cdsr reviews before use. There are a number of useful appraisal tools in the literature for assessing the quality of SRs such as: Sack s instrument (Sacks et al., 1987), and A Measurement Tool to Assess Systematic Review (AMSTAR) (Shea et al., 2009). However, it is challenging for nurse clinicians to conduct effective appraisal of SRs due to insufficient time and training (Chan et al., 2009). In recent years, more overviews of SRs which summarise and critically appraise multiple reviews have been published (Higgins and Green, 2011, Hoving et al., 2001, Payne et al., 2012). These overviews are useful in summarizing SRs addressing the effect of two or more potential interventions for a single condition or health problem (Chan et al., 2012, Coster and Norman, 2009, Higgins and Green, 2011). However, overviews of SRs may not be necessary if the quality of SRs can be assured and if critical appraisal is the only purpose of an overview. For example, Payne s overview of SRs investigated the effects of interventions for fatigue and weight loss in adults with advanced progressive illness (Payne et al., 2012). This overview reported 26 of the 27 included CDSR reviews were of a high methodological quality using the AMSTAR. However, it was difficult to assess the methodological quality of one of the included SRs because this particular SR did not have any included studies (Payne et al., 2012). In contrast, our recent overview of SRs in the area of radiation dermatitis in cancer patients demonstrated high variability in methodological quality amongst all the included SRs (Chan et al., 2012). Poor
methodological quality of SRs may subsequently have an impact on the clinical recommendations made (Chan et al., 2012). These data support the argument that nurses, healthcare professionals, and guideline developers can confidently use CDSR reviews without spending excessive time to appraise the SRs before use. Over the past years, the CDSR has not been without criticism. For example, CDSR reviews were criticised for its exclusion of evidence other than randomised controlled trials and high quality controlled trials (Douglas and Vora, 2011). We argue that such criticism applies to the movement of evidence based practice in general, rather than the CDSR alone. Other criticisms of CDSR reviews include their accessibility and complexity of the full CDSR reviews. However, it is also clear that the Cochrane Collaboration has been proactive in improving its accessibility with strategies such as redesigning and improving the website navigation, developing the Cochrane Journal Club, and the implementation of summary of findings tables (The Cochrane Collaboration, 2012). In summary, systematic reviews are widely regarded as the gold standard for informing evidence-based healthcare. There have been international efforts to improve the quality of SRs as a discipline of methodological science. The CDSR offers nurses confidence in the methodological standards of its reviews as does the ever improving operational plan of the Cochrane Collaboration. We recommend that, nurses, as the largest healthcare workforce contribute to the CDSR by supporting the utilization, conduct and
dissemination of CDSR reviews. We also challenge SR authors in nursing to consider conducting CDSR reviews when undertaking a SR.
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