- Email: [email protected]
Evidence based medicine reviews
ARTICLE IN PRESS Respiratory Medicine (2004) 98, 273–274
EDITORIAL
Evidence based medicine reviews In this issue we reintroduce the Evidence Based Reviews Section. This feature is aimed at updating clinicians and researchers about the management of respiratory disease. Some of the articles published in this section will be individual systematic reviews. Others will be linked overviews that summarise the results of a number of reviews dealing with related interventions for a particular disease. Reviews that have already been published in this section of the journal have included breathing retraining for asthma,1 spacers and nebulisers for the delivery of beta-agonists in acute asthma,2 antibiotics in the management of non-CF bronchiectasis,3 asthma education,3 NIPPV in chronic obstructive pulmonary disease4 and cardioselective beta-blockers in COPD.5 In contrast to the more familiar narrative reviews, systematic reviews attempt to minimise bias in the literature review process by applying a strict and objective process to the analysis of the available evidence. Where it is possible and appropriate to combine the data, this leads to a more reliable estimate of the average effect of a treatment. Because the trial evidence is laid out clearly the reader can inspect this for themselves. How the reviewers arrived at their conclusions should also be clear to the reader. Interested readers are encouraged to read the comprehensive introduction to the aims and methodology of systematic reviews by Paul Jones, who was the inaugural editor of this section.6 In 2003, Mike Clarke, co-chair of the steering group of the Cochrane Collaboration estimated that 10,000 systematic reviews were required to cover the range of health care interventions that have been studied in controlled clinical trials.7 Currently, the collaboration lists about 3000 reviews that are either completed or underway. Clearly there is still considerable scope for the development of systematic reviews of therapy. Overviews of systematic reviews are useful too. At the most practical level they provide a succinct summary for the busy clinician of the systematic review evidence for related interventions for
particular diseases. By identifying the existing systematic reviews, they allow the clinician to go back to these if desired, to themselves evaluate the strength of evidence for particular interventions. The overviews may indicate where more clinical trials and/or systematic reviews are required. They also allow an examination of the methodology as part of a critical appraisal of the systematic reviews. The first two publications in 2004 in the Evidence-Based Reviews section are overviews of systematic reviews, although they are quite different in approach. In this issue the use of corticosteroids in acute exacerbations of asthma is explored by looking at a number of systematic reviews on this topic.8 These reviews address the evidence for different doses, routes, timing and duration of corticosteroid therapy. In May, an overview of the systematic reviews of low molecular weight heparin (LMWH) versus unfractionated heparin (UFH) for the treatment of venous thromboembolic disease (VTE) will be published.9 This shows how the average effect size for treatment with LMWH has changed as more studies have been included in the reviews. We will continue to commission material for this section but we are also prepared to receive unsolicited systematic reviews or overviews that have not previously published, provided they conform to the aims of this section and have been developed using the appropriate methodology.
References 1. Ram FS, Holloway EA, Jones PW. Breathing retraining for asthma. Respir Med 2003;97:501–7. 2. Cates C. Spacers and nebulisers for the delivery of betaagonists in non-life-threatening acute asthma. Respir Med 2003;97:762–9. 3. Evans DJ, Greenstone M. Long-term antibiotics in the management of non-CF bronchiectasisFdo they improve outcome? Respir Med 2003;97:851–8. 4. Gibson PG, Ram FS, Powell H. Asthma education. Respir Med 2003;97:1036–44.
0954-6111/$ - see front matter & 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.rmed.2004.02.001
ARTICLE IN PRESS 274
5. Wijkstra PJ. Non-invasive positive pressure ventilation (NIPPV) in stable patients with chronic obstructive pulmonary disease (COPD). Respir Med 2003;97:1086–93. 6. Salpeter SR, Ormiston TM, Salpeter EE, Poole PJ, Cates CJ. Cardioselective beta-blockers for chronic obstructive pulmonary disease: a meta-analysis. Respir Med 2003;97: 1094–101. 7. Jones P. An introduction to systematic reviews in respiratory medicine. Respir Med 2003;97:97–103. 8. Clarke M. Systematic reviews, the Cochrane Collaboration, The Cochrane Collaboration 2003. Accessed from http:// www.cochrane.org/docs/whycc.html
Editorial
9. Rowe BH, Edmonds ML, Spooner CH, Diner D, Camargo CA. Corticosteroid therapy for acute asthma. Respir Med 2004;98:275–84.
Phillippa Poole Peter Black Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Aukland, New Zealand E-mail address: [email protected]
EDITORIAL
Evidence based medicine reviews In this issue we reintroduce the Evidence Based Reviews Section. This feature is aimed at updating clinicians and researchers about the management of respiratory disease. Some of the articles published in this section will be individual systematic reviews. Others will be linked overviews that summarise the results of a number of reviews dealing with related interventions for a particular disease. Reviews that have already been published in this section of the journal have included breathing retraining for asthma,1 spacers and nebulisers for the delivery of beta-agonists in acute asthma,2 antibiotics in the management of non-CF bronchiectasis,3 asthma education,3 NIPPV in chronic obstructive pulmonary disease4 and cardioselective beta-blockers in COPD.5 In contrast to the more familiar narrative reviews, systematic reviews attempt to minimise bias in the literature review process by applying a strict and objective process to the analysis of the available evidence. Where it is possible and appropriate to combine the data, this leads to a more reliable estimate of the average effect of a treatment. Because the trial evidence is laid out clearly the reader can inspect this for themselves. How the reviewers arrived at their conclusions should also be clear to the reader. Interested readers are encouraged to read the comprehensive introduction to the aims and methodology of systematic reviews by Paul Jones, who was the inaugural editor of this section.6 In 2003, Mike Clarke, co-chair of the steering group of the Cochrane Collaboration estimated that 10,000 systematic reviews were required to cover the range of health care interventions that have been studied in controlled clinical trials.7 Currently, the collaboration lists about 3000 reviews that are either completed or underway. Clearly there is still considerable scope for the development of systematic reviews of therapy. Overviews of systematic reviews are useful too. At the most practical level they provide a succinct summary for the busy clinician of the systematic review evidence for related interventions for
particular diseases. By identifying the existing systematic reviews, they allow the clinician to go back to these if desired, to themselves evaluate the strength of evidence for particular interventions. The overviews may indicate where more clinical trials and/or systematic reviews are required. They also allow an examination of the methodology as part of a critical appraisal of the systematic reviews. The first two publications in 2004 in the Evidence-Based Reviews section are overviews of systematic reviews, although they are quite different in approach. In this issue the use of corticosteroids in acute exacerbations of asthma is explored by looking at a number of systematic reviews on this topic.8 These reviews address the evidence for different doses, routes, timing and duration of corticosteroid therapy. In May, an overview of the systematic reviews of low molecular weight heparin (LMWH) versus unfractionated heparin (UFH) for the treatment of venous thromboembolic disease (VTE) will be published.9 This shows how the average effect size for treatment with LMWH has changed as more studies have been included in the reviews. We will continue to commission material for this section but we are also prepared to receive unsolicited systematic reviews or overviews that have not previously published, provided they conform to the aims of this section and have been developed using the appropriate methodology.
References 1. Ram FS, Holloway EA, Jones PW. Breathing retraining for asthma. Respir Med 2003;97:501–7. 2. Cates C. Spacers and nebulisers for the delivery of betaagonists in non-life-threatening acute asthma. Respir Med 2003;97:762–9. 3. Evans DJ, Greenstone M. Long-term antibiotics in the management of non-CF bronchiectasisFdo they improve outcome? Respir Med 2003;97:851–8. 4. Gibson PG, Ram FS, Powell H. Asthma education. Respir Med 2003;97:1036–44.
0954-6111/$ - see front matter & 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.rmed.2004.02.001
ARTICLE IN PRESS 274
5. Wijkstra PJ. Non-invasive positive pressure ventilation (NIPPV) in stable patients with chronic obstructive pulmonary disease (COPD). Respir Med 2003;97:1086–93. 6. Salpeter SR, Ormiston TM, Salpeter EE, Poole PJ, Cates CJ. Cardioselective beta-blockers for chronic obstructive pulmonary disease: a meta-analysis. Respir Med 2003;97: 1094–101. 7. Jones P. An introduction to systematic reviews in respiratory medicine. Respir Med 2003;97:97–103. 8. Clarke M. Systematic reviews, the Cochrane Collaboration, The Cochrane Collaboration 2003. Accessed from http:// www.cochrane.org/docs/whycc.html
Editorial
9. Rowe BH, Edmonds ML, Spooner CH, Diner D, Camargo CA. Corticosteroid therapy for acute asthma. Respir Med 2004;98:275–84.
Phillippa Poole Peter Black Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Aukland, New Zealand E-mail address: [email protected]