Marit Johansen

Methods to improve recruitment to randomised controlled trials: Cochrane systematic review and meta-analysis

This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2010, Issue 4, Art. No.: MR000013 DOI: 10.1002/14651858.MR000013.pub5 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review. Objective To identify interventions designed to improve recruitment to randomised controlled trials, and to quantify their effect on trial participation. Design Systematic review. Data sources The Cochrane Methodology Review Group Specialised Register in the Cochrane Library, MEDLINE, EMBASE, ERIC, Science Citation Index, Social Sciences Citation Index, C2-SPECTR, the National Research Register and PubMed. Most searches were undertaken up to 2010; no language restrictions were applied. Study selection Randomised and quasi-randomised controlled trials, including those recruiting to hypothetical studies. Studies on retention strategies, examining ways to increase questionnaire response or evaluating the use of incentives for clinicians were excluded. The study population included any potential trial participant (eg, patient, clinician and member of the public), or individual or group of individuals responsible for trial recruitment (eg, clinicians, researchers and recruitment sites). Two authors independently screened identified studies for eligibility. Results 45 trials with over 43 000 participants were included. Some interventions were effective in increasing recruitment: telephone reminders to non-respondents (risk ratio (RR) 1.66, 95% CI 1.03 to 2.46; two studies, 1058 participants), use of opt-out rather than opt-in procedures for contacting potential participants (RR 1.39, 95% CI 1.06 to 1.84; one study, 152 participants) and open designs where participants know which treatment they are receiving in the trial (RR 1.22, 95% CI 1.09 to 1.36; two studies, 4833 participants). However, the effect of many other strategies is less clear, including the use of video to provide trial information and interventions aimed at recruiters. Conclusions There are promising strategies for increasing recruitment to trials, but some methods, such as open-trial designs and opt-out strategies, must be considered carefully as their use may also present methodological or ethical challenges. Questions remain as to the applicability of results originating from hypothetical trials, including those relating to the use of monetary incentives, and there is a clear knowledge gap with regard to effective strategies aimed at recruiters.

Curative ablation for atrial fibrillation: a systematic review.

Objective. To perform a systematic review of randomized controlled trials (RCTs) on catheter ablation for atrial fibrillation (AF). Background. Radiofrequency catheter (RF)-ablation around pulmonary vein ostia and in left atrium may reduce or prevent recurrence of AF, as documented in observational studies and registry reports; however, few RCTs are available. Methods. Using relevant search phrases, Cochrane Library, MEDLINE and EMBASE were searched for RCTs, last time in May 2007. Titles and abstracts were screened. When entry criteria were fulfilled, full-text papers were read and graded according to quality and relevance. Results. One thousand and ninety four abstracts were evaluated, and five RCTs included (578 randomized patients). The studies had moderate quality and relevance, but the results were consistent: ablation is better than drug treatment in preventing AF recurrence; the relative risk (95% CI)) one year after ablation ranged from 0.20 (0.08–0.51) to 0.62 (0.39–0.99). Conclusions. Results from observational and registry studies are confirmed: RF-ablation reduces recurrence rate of AF, and can be done with few serious complications. Limitations are few patients >70 years, and only one year follow-up.

“A waste of time without patients”: The views of patient representatives attending a workshop in evidence‐based practice

Shared decision‐making is a central element of evidence‐based practice (EBP). Training in EBP has traditionally focused on providers, but there is an increasing interest in developing such educational resources for patients. The aim of this study is to explore the views of patient representatives attending a workshop in EBP.

A comparative evaluation of PDQ-Evidence

BackgroundA strategy for minimising the time and obstacles to accessing systematic reviews of health system evidence is to collect them in a freely available database and make them easy to find through a simple ‘Google-style’ search interface. PDQ-Evidence was developed in this way. The objective of this study was to compare PDQ-Evidence to six other databases, namely Cochrane Library, EVIPNet VHL, Google Scholar, Health Systems Evidence, PubMed and Trip.MethodsWe recruited healthcare policy-makers, managers and health researchers in low-, middle- and high-income countries. Participants selected one of six pre-determined questions. They searched for a systematic review that addressed the chosen question and one question of their own in PDQ-Evidence and in two of the other six databases which they would normally have searched. We randomly allocated participants to search PDQ-Evidence first or to search the two other databases first. The primary outcomes were whether a systematic review was found and the time taken to find it. Secondary outcomes were perceived ease of use and perceived time spent searching. We asked open-ended questions about PDQ-Evidence, including likes, dislikes, challenges and suggestions for improvements.ResultsA total of 89 people from 21 countries completed the study; 83 were included in the primary analyses and 6 were excluded because of data errors that could not be corrected. Most participants chose PubMed and Cochrane Library as the other two databases. Participants were more likely to find a systematic review using PDQ-Evidence than using Cochrane Library or PubMed for the pre-defined questions. For their own questions, this difference was not found. Overall, it took slightly less time to find a systematic review using PDQ-Evidence. Participants perceived that it took less time, and most participants perceived PDQ-Evidence to be slightly easier to use than the two other databases. However, there were conflicting views about the design of PDQ-Evidence.ConclusionsPDQ-Evidence is at least as efficient as other databases for finding health system evidence. However, using PDQ-Evidence is not intuitive for some people.Trial registrationThe trial was prospectively registered in the ISRCTN registry 17 April 2015. Registration number: ISRCTN12742235.

Integrated community case management of childhood illness in low‐ and middle‐income countries

This is a protocol for a Cohrane Rewiew (intervention). The objectives are as follows: To assess the effects of the integrated community case management (ICCM) strategy for children younger than fi ...

Den norske EPOC-satellitten: støtte til kunnskapsbaserte beslutninger

Systematiske oversikter fra det internasjonale Cochrane-samarbeidet er en viktig kilde til oppsummert kunnskap for beslutningstakere i helsevesenet. Den norske satellitten av Cochrane Effective Practice and Organisation of Care (EPOC) Review Group har base i Seksjon for global helse, Nasjonalt kunnskapssenter for helsetjenesten, og fokuserer pa tiltak som retter seg mot helsesystemer og helsetjenesten i lav- og mellominntektsland. Den norske EPOC-satellitten gir redaksjonell stotte til forfattere som skriver Cochraneoversikter om effekter av slike tiltak, og bidrar dermed til at systematiske oversikter blir utarbeidet og brukt. Behovet for oppsummert kunnskap, skreddersydd for ulike sammenhenger og ulike sluttbrukere, er stort. Ikke minst gjelder det i lav- og mellominntektsland der ressursene er begrenset, og der gode prioriteringer er spesielt viktig. Munabi-Babigumira S, Johansen M, Paulsen E. The Norwegian EPOC-satellite: Support for evidenceinformed decisions . Nor J Epidemiol 2013; 23 (2): 211-214. ENGLISH SUMMARY Systematic reviews from the Cochrane Collaboration are an important source of summarised evidence for decision makers in health care. The Norwegian satellite of the Cochrane Effective Practice and Organisation of Care (EPOC) Review Group has its base at the Global Health Unit in the Norwegian Knowledge Centre for the Health Services, and focuses on interventions targeting health systems and services in lowand middle-income countries. The Norwegian EPOC-satellite provides editorial support to authors who write systematic reviews on the effects of such interventions, and contributes to building the capacity for producing and using systematic reviews. The need for summarised evidence, tailored for various settings and various end users, is large. This is particularly important for low- and middle income countries, where resources are limited and it is important to identify the right priorities.

New treatments compared to established treatments inrandomized trials (Review)

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effectiveness of anti-adhesion therapy versus placebo, no therapy or an alternative anti-adhesion therapy following operative hysteroscopy for the treatment of female subfertility.To determine the efficacy and safety of metformin in treating women with endometrial hyperplasia