Clinical Trials and Systematic Reviews: Managing Information Overload

From the blog Open Medicine dated October 4th, 2010

Bastian H, Glasziou P, Chalmers I (2010) Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? PLoS Med 7(9): e1000326. doi:10.1371/journal.pmed.1000326

Published: September 21, 2010

• When Archie Cochrane reproached the medical profession for not having critical summaries of all randomised controlled trials, about 14 reports of trials were being published per day. There are now 75 trials, and 11 systematic reviews of trials, per day and a plateau in growth has not yet been reached.
• Although trials, reviews, and health technology assessments have undoubtedly had major impacts, the staple of medical literature synthesis remains the non-systematic narrative review. Only a small minority of trial reports are being analysed in up-to-date systematic reviews. Given the constraints, Archie Cochrane’s vision will not be achieved without some serious changes in course.
• To meet the needs of patients, clinicians, and policymakers, unnecessary trials need to be reduced, and systematic reviews need to be prioritised. Streamlining and innovation in methods of systematic reviewing are necessary to enable valid answers to be found for most patient questions. Finally, clinicians and patients require open access to these important resources. [editor Flahiff’s emphasis]
  

If the results of a clinical study are published in a scientific journal, PubMed is the best way to search for information about the article. If you are having challenges searching PubMed, consider the tutorial at the home page of PubMed. You may also ask a reference librarian at a local public, academic, or medical library. Call ahead to see what level of assistance they offer.

Clinicaltrials.gov has the voluntary summaries of some clinical trials. Advanced search has the option Study results (select Studies With Results). Some results may be labelled “proprietary” (information not released to the public, sometimes called “industry secrets” ).

Making Scientific Research Accessible to All

 

Melissa Hagemann. Photo: Laura Brahm for the Open Society Foundations

 

 

[Related to recent posting here Access to Knowledge for Consumers]

Excerpts from the interview with Melissa Hagemann about the Open Access Movement.
She is program manager in the Open Society Foundations Information Program. She’s also on the advisory board of theWikimedia Foundation, which operates Wikipedia

What is “Open Access”?

Open Access refers to the free online availability of research literature. It was first defined at a meeting organized by the Open Society Foundations in 2001, which led to the Budapest Open Access Initiative.  This initiative outlined two strategies for developing OA:

• Open Access Journals, which are journals, freely available worldwide, which do not rely upon the traditional subscription-based business model to generate their revenue; and
• Open Repositories, or archives where all scholarly research articles published by those associated with a university or within a discipline can be deposited.

In 2003, we added a third strategy, which is to advocate for public access to publicly funded research.

What are some of the most notable accomplishments of the open access movement so far?

Probably the single most important victory was a mandate adopted by the U.S. Congress which stipulates that all research funded by the National Institutes of Health (about $29 billion annually) be made freely available online.

While the NIH is the largest funder of research in the world, the OA movement has worked with governments and universities throughout the world to adopt similar mandates, and today there are 230 of them. In addition, there are over 5,500 OA journals and over 1,700 open repositories.

What major obstacles does the movement face at this moment?

As Open Access is so new, one of our main challenges is simply raising awareness of it and explaining the benefits of this new model.  At the same time, you can imagine that many within the publishing industry haven’t always been keen supporters of OA.

But I’m curious: How can the publishing industry benefit from Open Access? Wouldn’t they say they need the money to continue publishing? How do you persuade them that OA is a good thing?

While OA journals are freely available online, about half of them charge a processing fee (anywhere from $500 to $3,000 or so) per article. So there are commercial OA journal publishers which are doing quite well. Actually one of the largest OA publishers, BioMed Central, was purchased by Springer (the second largest scientific journal publisher) in 2008, and Springer pledged to keep all of the journals OA.

How can others get involved in advancing the issue?

Participating in an event during OA week is a great way to start! Then I would suggest learning more about OA, and OASIS is one of the best resources for information on the OA movement.

• If you’re a student, I recommend connecting with the Right to Research Coalition.
• If you’re an academic, you can self-archive copies of your research articles in your institutional repository or submit your article to anOA journal. You can also advocate for your institution to adopt an OA mandate at your university; 230 mandates have been adopted worldwide (see www.eprints.org/openaccess/policysignup).
• If you’re in a developing or transition country, the EIFL Open Access Program offers a wealth of support and services for librarians, academics, policymakers, and funders in these countries to tap into.
• If you’re based in the United States, you can support the Alliance for Taxpayer Access, which advocates for public access to publicly funded research in the U.S.

 

 

 

 

 

 

Mediterranean Diet May Trim Diabetes Risk

From a Reuters Health Information press release (October 14, 2010)

By Amy Norton

NEW YORK (Reuters Health) – Older adults who stick with a traditional Mediterranean diet rich in plant-based fats may help lower their risk of type 2 diabetes — even without counting calories or shedding weight, new research hints.

In a study of 418 older Spanish adults, researchers found that those instructed to follow a Mediterranean diet were less likely to develop diabetes over four years than those instructed to follow a low-fat diet — about 10 percent developed the disease, versus 18 percent in the low-fat group. And weight loss did not appear necessary to gain the benefit.

The findings, reported in the journal Diabetes Care, may sound too good to be true.

But they back up previous work by the same researchers showing that the Mediterranean diet, even without weight loss, appeared to curb the risk of metabolic syndrome — a collection of risk factors for diabetes that includes abdominal obesity, high blood pressure and elevated blood sugar and triglycerides.

However, even if the eating pattern brings benefits in the absence of weight loss, that does not negate the importance of regular exercise or calorie-consciousness, a spokesperson for the American Dietetic Association told Reuters Health.

For further information on diabetes, consider starting with the MedlinePlus topic Diabetes

For further information on the Mediterranean diet, consider starting with the Mayo Clinic Web page Mediterranean diet: Choose this heart-healthy diet option and the American Heart Association Web page Mediterranean diet.

Remember, consult with your (state licensed) health care practitioners if you have any health concerns, including diet changes.

 

More Evidence That Compression-Only CPR Works Best

Avoiding mouth-to-mouth allows responders to keep blood flowing, researchers say

From the October 14, 2010 Health Day news item

THURSDAY, Oct. 14 (HealthDay News) — Emergency dispatchers should advise bystanders to use chest-compression-only CPR on heart attack victims, rather than the standard protocol of chest compressions and mouth-to-mouth ventilation, according to a new study.

The findings echo the results of other recent reports that have compared the two strategies.

Continuous, uninterrupted chest compressions may be the key to successful CPR, according to this team of American and Austrian researchers.

“By avoidance of rescue ventilations (mouth-to-mouth) during CPR, which are often fairly time-consuming for lay bystanders, a continuous uninterrupted coronary perfusion pressure is maintained, which increases the probability of a successful outcome,” they wrote in the Oct. 14 online edition of The Lancet.

[Editor Flahiff’s note: Full text of this article is by paid subscription only. Check with a local public, academic, or medical library to see if the article is available or can be obtained from another library. There may be a charge.
Call ahead and ask for a reference librarian.]

In addition, chest-compression-only CPR is easier to perform, which increases the likelihood that bystanders will be willing and able to help heart attack victims, the team said……..

The new findings echo those of recent studies. For example, in September a team from the University of Michigan reported that patients who experience sudden cardiac arrest outside of a hospital setting fare just as well when treated with chest compressions before being treated with an electrical defibrillator as they do when getting immediate defibrillation. That study appeared in the journal BMC Medicine.

And in July, two studies published in the New England Journal of Medicine each found that chest compression alone was equal to compressions plus mouth-to-mouth when it came to helping people experiencing a heart attack.

[Editor Flahiff’s note: If you need help  figuring out  the referred issues of BMC Medicine and NEJM,
email me at jmflahiff@yahoo.com. I will have an answer within 48 hours.]