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Cochrane Canada 9th Annual Symposium

Vancouver, BC 16 - 17 February 2011 Presymposium 14 - 15 February 2011

Early Exposure to our Sponsors
A big Thank You from Cochrane Canada
Platinum: Gold:

Silver:

Exhibitors:

Early Exposure to Cochrane: Accessible - Credible - Practical

Welcome from our Chair
Dear Colleagues, We are delighted to welcome you to Vancouver for the 9th Annual Cochrane Canada Symposium 2011! This year’s title, Early Exposure to Cochrane: Accessible, Credible, Practical, reflects the fact that we believe health professional students are not being exposed to the Cochrane mission, principles and the Library early enough in their education. If the Cochrane Collaboration is going to achieve its goal of being the go-to place for reliable unbiased answers to health care questions, we need to make many more young people aware of, knowledgeable about, and enthusiastically using and promoting The Cochrane Library. We, therefore, believe we need to explicitly put pressure on health professional schools to introduce Cochrane methodology and evidence into the curriculum at an early stage. Furthermore, reinforcement of this knowledge during training must be sufficient to ensure that all graduates are Cochrane aficionados. In this context, planning for the Symposium centred on three themes: improving the accessibility of Cochrane evidence; making sure the evidence is compiled in a rigorous and unbiased way so it is credible, and ensuring the evidence delivered is user friendly, understandable and practical. We hope you will find the program reflects these themes and you enjoy it! This event could not be a success without the dedication to excellence of many: We thank the Steering Committee for their expertise and input into planning the event. We thank the Scientific Committee for their time in vetting the record number of abstracts we received. We thank the plenary speakers, session and workshop presenters and poster presenters for contributing to the themes and learning objectives of this Symposium. Finally, we thank the team at the Hypertension Review Group and the Canadian Cochrane Centre for their commitment to making this a great experience for all participants. We welcome you and hope you enjoy a time of learning, making new acquaintances or renewing old ones, and enjoying an early spring here in Vancouver! Best wishes,

Jim Wright Symposium Steering Committee Chair

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Cochrane Canada 9th Annual Symposium

Take a Bow
Cochrane Canada recognizes our Symposium Committees
Steering Committee Anne McFarlane Jim Wright (Chair) Christopher Adlparvar Alan Cassels Jeremy Grimshaw Paul Hendry Bev Holmes Ciprian Jauca Arminee Kazanjian Anne Lyddiatt Bikaramjit Mann Lisa McGovern Vijaya Musini Bob Nakagawa Doug Salzwedel Mary Ellen Schaafsma Adrienne Stevens Lori Tarbett Eileen Vilis Scientific Committee Alain Mayhew Eileen Vilis (Chair) Susan Bartlett Rachel Bennett Stephen Bornstein Alan Cassels Michelle Fiander Patricia Fortin Carolyn J. Green Jill Hayden Joanne Homik Arminee Kazanjian Graduate Student Poster Award Committee Joel Gagnier Adrienne Stevens (Chair) Marion Doull Kara DeCorby Jordi Pardo Pardo Victoria Pennick Cochrane Review of the Year Committee Adrienne Stevens (Chair) Luis Gabriel Cuervo Jeremy Grimshaw Grigorios Leontiadis Lucy Turner Session Moderators Vijaya Musini Joseph Beyene Alan Cassels Jeremy Grimshaw Ciprian Jauca John MacDonald Alain Mayhew Anne McFarlane About the Cochrane Hypertension Review Group The Cochrane Hypertension Review Group is an international organization committed to helping people make well-informed decisions about the prevention and treatment of hypertension by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions for hypertension. The Group is located at the University of British Columbia, Vancouver, BC. Bob Nakagawa Jordi Pardo Pardo Victoria Pennick Mary Ellen Schaafsma Jim Wright About the Canadian Cochrane Centre The Canadian Cochrane Centre (CCC), registered in August 1993, is one of 14 independent, not-for-profit Centres of The Cochrane Collaboration worldwide. The CCC is located at the Institute for Population Health at the University of Ottawa. We support the activities of over 2,067 members of The Cochrane Collaboration in Canada to promote the Collaboration, The Cochrane Library, and evidence-based health care in Canada. We collaborate with health professional organizations, health researchers, health technology assessment groups, national consumer associations, governments and other interested groups in order to achieve this goal. The CCC is a part of Cochrane Canada which is composed of 1,200 review authors, six Review Groups, two Methods Groups, one Field and 18 Regional Sites. A Special Thank You We would like to extend a special thank you to the Canadian Institutes of Health Research (CIHR) who have been our primary funder over the past five years, and through the next five (grant # No. CON-105145). Without the support of CIHR, we would not have achieved the success we have today. Jessie McGowan Barbara Mintzes David Moher Jordi Pardo Pardo Pierre Pluye Mary Ellen Schaafsma Adrienne Stevens Darlene Therrien Erin Ueffing

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Early Exposure to Cochrane: Accessible - Credible - Practical

Early Exposure to our Exhibitors

Wiley Blackwell is the international scientific, technical, medical and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world’s leading societies. WileyBlackwell publishes nearly 1,500 peer-reviewed journals as well as 1,500+ new books annually in print and online as well as databases, major reference works and laboratory protocols. The Cochrane Library, published by Wiley-Blackwell on behalf of The Cochrane Collaboration since 2003, includes seven databases covering all aspects of evidence-based health care, including the Cochrane Database of Systematic Reviews which has a 2009 Impact Factor of 5.653. Please visit the Wiley-Blackwell booth to pick up your Quick Reference Guide to The Cochrane Library and other free samples including notepads, pens and bookmarks.

Health Evidence is a service and research organization involved in knowledge translation among Canada’s public health decision makers. Located at McMaster University, Hamilton, Health Evidence offers a suite of services aimed at supporting the development of knowledge, skill and culture for evidenceinformed decision making (EIDM). Our key resource, the www. health-evidence.ca registry of systematic reviews, provides free, user-friendly access to a searchable database of public health relevant, quality-appraised reviews. Tailored capacity assessments for EIDM, workshops and presentations on EIDM ‘how to’, and Knowledge Broker services to mentor individuals/ teams/organizations in working toward EIDM are available to support incorporation of evidence into practice.

CADTH is an independent, not-for-profit agency funded by Canada’s federal, provincial, and territorial governments. CADTH’s mandate is to deliver reliable, timely, evidencebased information to Canada’s health care leaders about the effectiveness and efficiency of health technologies (drugs, vaccines, devices and equipment, medical and surgical procedures) through a variety of products and services.

The Provincial Infection Control Network of British Columbia (PICNet) is a provincially supported infection control knowledge collaborative that provides guidance and advice on healthcare associated infection prevention and control in British Columbia. PICNet connects health care professionals from across the province to develop and create guidelines and tools, with a focus on surveillance, evidence-based practice, and education. PICNet’s resources are also accessible to all healthcare providers through the PICNet website: www.picnetbc.ca.

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Presymposium Program
Monday 14 February and Tuesday 15 February 2011
Cochrane Standard Author Training When: 14 and 15 February, 8:30 a.m. - 5 p.m. Faculty: Adrienne Stevens, Education Coordinator, Canadian Cochrane Centre Arminee Kazanjian, Professor, University of British Columbia Ediweera Desapriya, Research Associate, University of British Columbia Douglas Salzwedel, Trials Search Coordinator, Cochrane Hypertension Review Group Michael Wasdell, Epidemiologist, Fraser Health Authority Lucy Turner, Coordinator, Cochrane Bias Methods Group Vijaya Musini, Assistant Professor, University of British Columbia Alain Mayhew, Managing Editor, Cochrane Effective Practice and Organisation of Care Group (EPOC) Review Group Synopsis: Take this two-day session to learn the basic skills of conducting a Cochrane Review. Topics include protocols, setting your question, literature searching, study selection, assessing bias, data and analysis, formulating conclusions, and a handson session with the Review Manager software. Cochrane Evidence for Healthcare Providers When: 15 February, 9 a.m. – 12 p.m. Synopsis: The Cochrane Collaboration is an enterprise that rivals the Human Genome Project in its potential implications for modern medicine. - The Lance. The systematic reviews produced by The Cochrane Collaboration are considered the gold standard of evidence. However, busy front-line healthcare practitioners do not always use this resource in their practice. Participants in this workshop will learn about Cochrane systematic reviews: how they are produced, how can they be used by front-line healthcare providers both in their daily practice and for advancing their continuing medical education needs. The workshop will combine interactive presentations with small group work and large group discussion, intended to allow participants time to become familiar with The Cochrane Library. Use of Cochrane will be demonstrated hands-on using several topical questions that clinicians may be asking. Bring your own questions for live search demonstrations!

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Early Exposure to Cochrane: Accessible - Credible - Practical

Health Systems Evidence – Evidence to support policymaking and management When: 15 February, 9:30 - 11:30 a.m. Faculty: Michael Wilson, Research Fellow, McMaster University Synopsis: Find decision-relevant research evidence at www. healthsystemsevidence.org – a continuously updated repository of syntheses of research evidence about governance, financial and delivery arrangements within health systems, and about implementation strategies that can support change in health systems. Participants in this workshop will learn about Health Systems Evidence . . . why use it, what’s in it, how to search it, what a search will retrieve, and how to sign up to receive monthly updates. Use of Health Systems Evidence will be demonstrated using several topical questions that policymakers, managers and stakeholders may be asking. Bring your own questions for live search demonstrations!

Knowledge Translation for Researchers: What do we know about Why, What and How? This workshops is sponsored in part by the Public Health Agency of Canada

When: 15 February, 1 - 4 p.m. Faculty: Donna Ciliska, Professor, McMaster University Kara DeCorby, Research Coordinator, McMaster University Synopsis: This presymposium workshop will describe what is known about the “what, why, and how to’s” of knowledge translation (KT), with a particular focus on the roles of the researcher and decision maker in KT. The presenters will draw from their KT experience with collaborative work and research in the public health sector. This workshop is for researchers and practitioners who want to learn about KT strategies and tactics that have been applied and tested and about how to develop effective KT plans. The workshop will focus on effective KT through the perspectives and experiences of the presenters. Several key questions that researchers and decision makers may be asking will frame the facilitated discussion:
    

Why do KT? What are different KT approaches? What is known about what works and doesn’t work? What KT tools are available? How is KT integrated in moving research into action?

The workshop format will combine interactive presentation with small group work and large group discussion, intended to allow participants time to problem-solve individual and shared KT questions, with time for feedback from the larger group and facilitators. Participants should bring their own KT questions and examples (effective and ineffective) for discussion.

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Program-at-a-Glance Wednesday 16 February 2011
Time 7 - 8:25 a.m. 8:30 - 10 a.m. Session Registration Welcome: Dr Jim Wright; Coordinating Editor, Cochrane Hypertension Group Opening Remarks: Dr Penny Ballem; City Manager, Vancouver Plenary I: Accessing the Best Evidence Early Speakers: Dr Jeremy Grimshaw: Access to The Cochrane Library; results of a pilot license for Canada Alan Cassels: Evidence, the media and what the public hears; How to increase understanding and access to the best evidence Dr Ian Scott: Early exposure to the best evidence: Moving from the classroom to the exam room Moderator: Jim Wright Refreshment break; poster and exhibit viewing Parallel Session I Workshop 1: Accessible Mayhew: Presenting the Results of Complex Reviews using Summary of Findings Tables Workshop 2: Credible Tejani: Don’t put the cart before the horse (Using the hierarchy of logical questioning for systematic reviews) Workshop 3: Practical Brien: Connecting with Others: Putting Scoping Review Methodology into Action Oral Session 1: Practical Moderator: Vijaya Musini Balram: Salivary and oral fluid based HIV antibody assays for rapid diagnosis of HIV infection Bennett: Does Age Moderate CBT Treatment Effects in Child and Adolescent Anxiety?: Results from an Individual Patient Data Meta-Analysis Jennings: Smart-testing of blood glucose: The road from evidence to practice change in British Columbia Roshanov: Computerized clinical decision support systems for chronic disease management: A decision-maker-researcher partnership systematic review Location 3rd Floor Corridor, near stairs Star Sapphire Ballroom

10 - 10:30 a.m. 10:30 a.m. - 12 p.m.

Corridor outside Star Sapphire Ballroom Star Sapphire Ballroom

Emerald A

Jade Ballroom

Pearl Room (Level 2)

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Early Exposure to Cochrane: Accessible - Credible - Practical

Time

Session Oral Session 2: Credible Moderator: Ciprian Jauca Embuldeniya: Using meta-ethnography to develop a conceptual model on the perceived impact and experience of participating in peer support interventions Gagnier: An empirical study using permutation based resampling in meta-regression Pardo Pardo: Equity in Systematic Reviews: New Guidance for Review Authors Ueffing: Sex- and gender-based analyses in systematic reviews: methods and lessons learned for Cochrane Oral Session 3: Accessible Moderator: Eileen Vilis Panel: Everything you ever wanted to know about consumer involvement in Cochrane Speakers: Anne Lyddiatt, Mary Brachaniec, Elizabeth (Liz) Whamond and Catherine McIlwain Lunch Poster viewing (12:40 - 1 p.m.) Parallel Session II Workshop 4: Accessible Santesso: How to use GRADEpro software to create Summary of Findings Tables Workshop 5: Credible Turner: Investigating and Dealing with Bias in Systematic Reviews Workshop 6: Practical Giustini: Using Social Media to Promote Evidence-Based Practice: A Primer on Blogs, Wikis and Twitter Oral Session 4: Accessible Moderator: Anne McFarlane DeCorby: Collaborative development of capacity development workshops to promote local evidence-informed decision making Stevens: Cochrane Canada Live: Webinars for Cochrane and beyond Wilson: Effects of an evidence service on health system policymakers’ use research evidence: A protocol for a randomized controlled trial

Location Emerald B & C

Topaz Room (Level 2)

12 - 1 p.m. 1 - 2:30 p.m.

Star Sapphire Ballroom

Star Sapphire Ballroom

Emerald A Jade Ballroom

Pearl Room (Level 2)

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Time

Session Oral Session 5: Practical Moderator: Alan Cassels Adlparvar: Bringing Cochrane Evidence to Frontline Clinicians Garritty: Evidence Mapping to Inform the Prevention, Treatment and Harms Reduction for Illicit Drug Use: A Practical Exercise Mintzes: What information are pharmaceutical sales representatives providing to family physicians? A comparative study in three countries Roshanov: Are computerized clinical decision support systems effective at improving the process of care and patient outcomes, and what makes an effective system? A decision-maker-researcher partnership systematic review Refreshment break; poster and exhibit viewing Parallel Session III Workshop 7: Accessible Schünemann: How to use the GRADE approach to assess the quality of the evidence in systematic reviews Workshop 8: Credible Beyene: Dealing with heterogeneity in meta-analysis Workshop 9: Practical Ueffing: Logic Models: Mapping Complex Interventions Oral Session 6: Credible Moderator: Alain Mayhew Cheung: Identifying priority content area gaps in health services and policy research Pardo Pardo: Searching or finding? Recommendations for equity relevant searches. Turner: A survey of the completeness of safety reporting in Complementary and Alternative Medicine (CAM) trials Oral Session 7: Practical Moderator: Mary Ellen Schaafsma Taylor: Drug Use Optimization (DUO) at the British Columbia (BC) Ministry of Health Services, Pharmaceutical Services Division: Decreasing demand by increasing evidence-based knowledge translation Green: A Systematic Review of Pharmaceutical Policies that Restrict Reimbursement Skidmore: Using Evidence-based Research to Inform Practice in a Medical Specialty Society

Location Emerald B & C

2:30 - 3 p.m. 3 - 4:15 p.m.

Corridor outside Star Sapphire Ballroom Star Sapphire Ballroom

Emerald A Jade Ballroom Pearl Room (Level 2)

Emerald B & C

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Time 4:15 - 5:30 p.m. 6:30 p.m.

Session Annual Stakeholder Meeting Social Event Cocktails followed by dinner at Top of Vancouver 555 West Hastings Street

Location Star Sapphire Ballroom

Annual Stakeholder Meeting Please join us for our Cochrane Canada Annual Stakeholder Meeting. We invite all Cochrane Canada members – entities, partners and regional site representatives – along with anyone else who is interested in learning more about what we’ve accomplished and where we plan to go. The meeting will be held from 4:15 to 5:30 p.m. in the Star Sapphire Ballroom. Simultaneous translation will be available. We look forward to seeing you there!

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Cochrane Canada 9th Annual Symposium

Top of the Evening at the Top of Vancouver
Social Event - Wednesday 16 February 2011 at 6:30 p.m.

Join your Cochrane colleagues for dinner at the Top of Vancouver revolving restaurant on the evening of Wednesday 16 February 2011. Top of Vancouver offers fine continental dining at 167m for an unobstructed view of Vancouver, the coast, mountains and the ocean. Windows are carefully angled for maximum viewing of the city below. One revolution is completed every 60 minutes.

Pre-dinner (6:30 p.m.)  Complimentary beverage  Hors-d’oeuvres

Three course dinner (7:30 p.m.)  Complimentary beverage  Caesar salad A stunning combination of great food and a magical panoramic view will combine for an evening you won’t  Three main course options (salmon, New York steak, or portobello mushroom fettuccini) want to miss!  Maple custard
www.topofvancouver.com

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Program-at-a-Glance Thursday 17 February 2011
Time 8:30 - 10 a.m. Session Plenary II: Credibility of the Evidence: Are there gaps?

Location Star Sapphire Ballroom

Cochrane Review of the Year Award presentation

Speakers: Anita Palepu: Improving credibility in journal publishing: An editor’s perspective of the importance of credible evidence being open and available. Mark Petticrew: Can you get a credible answer from systematic reviews without RCTs? A public health perspective Anne McFarlane: From Decision-maker to Consumer: How does your need for evidence change when you are the patient? Moderator: Jeremy Grimshaw Refreshment break; poster and exhibit viewing Parallel Session IV Workshop 10: Credible Fiander: Reference Management for Systematic Reviews Workshop 11: Practical Perry: Real patient video can illustrate the use of Cochrane Systematic Reviews Workshop 12: Practical Konnyu: The reality of rapid reviews Oral Session 8: Accessible Moderator: John MacDonald Gunderson: Knowledge Translation by Consumers: A case series on the promotion of The Cochrane Collaboration Albrecht: A Systematic Review on Research Implementation in Allied Health Professions Mallidou: A systematic review examining organizational characteristics that influence knowledge translation in healthcare Wilson: A ‘Rapid Response’ service for community-based organizations in the HIV/AIDS sector

10 - 10:30 a.m. 10:30 - 11:45 a.m.

Corridor outside Star Sapphire Ballroom Star Sapphire Ballroom Jade Ballroom

Emerald A Pearl Room (Level 2)

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Cochrane Canada 9th Annual Symposium

Time

Session Oral Session 9: Practical Moderator: Jordi Pardo Pardo Goldsmith: Database Search Order Can Be Made More Efficient Roshanov: How can we discover clinicians’ real-world medical knowledge retrieval patterns? Tejani: The perfect threesome: students, clinician researchers, and Cochrane

Location Emerald B & C

Rhainds: Surgical smokes in the operating theatre: Using best evidence for health risk assessment 11:45 a.m. - 12:30 p.m. Lunch; poster and exhibit viewing (12:15 - 12:30 p.m.) 12:30 - 2 p.m. Parallel Session V Workshop 13: Accessible

Star Sapphire Ballroom Star Sapphire Ballroom

Moralejo: Selecting Studies for Inclusion in a Review: Not an Easy Task Workshop 14: Credible Pearl Room (Level 2) Doull: To whom does the evidence apply? Addressing sex and gender to enhance the credibility of systematic reviews Workshop 15: Practical Petticrew: Extrapolation: Applying the results from systematic reviews to whom, when, and how? Workshop 16: Practical Kastner: How can we make sense of Cochrane Reviews of complex interventions? Consideration of three complementary synthesis methods (realist review, meta-narrative, meta-ethnography) to better understand the ‘how’ and ‘why’ of findings Oral Session 10: Accessible Moderator: Victoria Pennick Robeson: Health-evidence.ca: A Canadian resource facilitating access and use of review-level evidence Rader: Making Decisions using Cochrane evidence: A practical tool for patients and their health care providers Gunderson: Consumer Impact On Arthritis Research Walsh: Consumer Support in Difficult Times Through Patient-to-Patient Information about The Cochrane Collaboration: A Case Study

Jade Ballroom

Emerald A

Topaz Room (Level 2)

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Time

Session Oral Session 11: Credible Moderator: Joseph Beyene Laugarotte: A comparison of the reporting of adverse outcomes in Cochrane versus non-Cochrane reviews Ghogomu: Overcoming methodological challenges associated with network meta-analyses: The experience of the Musculoskeletal Group

Location Emerald B & C

2 - 2:30 p.m. 2:30 - 4 p.m.

Turner: The influence of CONSORT on the quality of RCTs: An updated review Refreshment break; poster and exhibit viewing Corridor outside Star Sapphire Ballroom Closing Plenary III: Practical Evidence: Maximizing the use and Star Sapphire Ballroom usefulness of what we know Speakers: Johanna Trimble: “Is Your Mom on Drugs? - Find out what to do about it” Bikaramjit Mann: Injecting practical aspects of evidence into education Dr Brian Haynes: Who needs to learn/teach/do critical appraisal when you have easy access to evidence-based summaries, synopses, syntheses, and studies? Moderator: Bob Nakagawa

Graduate Student Poster Award presentation

Closing Remarks and 2012 Symposium announcement: Dr Jim Wright

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Plenaries
Plenary I: Accessing the Best Evidence Early Wednesday 16 February 2011, 8:45 - 10 a.m.; Star Sapphire Ballroom Health care providers want to offer the best and safest care available; personal level health care decisions should be wellinformed by reliable sources; and health systems decisionmakers need the knowledge to deliver solid and affordable care. Access is key (as early as possible) to the implementation of the best available evidence. Health professionals entering the field relied on textbooks, teachers and journal databases in school – but as a busy practitioner, how do they stay up-to-date on the latest evidence and ensure their practice is current? For that matter, where do teachers and mentors direct the next generation of health care professionals for the best sources of information to inform their clinical decisions? We know many individuals ‘Google’ their health conditions to find out what treatments are available. They may read articles in the newspaper or hear about a treatment on a television health segment, but how reliable is this information? These are significant issues and the speakers in this plenary will speak to each of them to help us understand how to improve timely access to the evidence for all.

but what do we do when this research design is not available to us? Are there ways to mine the existing health research when there is a paucity of published RCTs and still come up with a credible answer? What about understanding the best diagnostic tools or what the likely outcomes of a treatment are in terms of prognosis? How do we encourage researchers to conduct the highest quality of research to input into systematic reviews health treatments? We will explore these questions in this plenary from various perspectives.

Anita Palepu: Improving credibility in journal publishing: An editor’s perspective of the importance of credible evidence being open and available Mark Petticrew: Can you get a credible answer from systematic reviews without RCTs? A public health perspective Anne McFarlane: From Decision-maker to Consumer: How does your need for evidence change when you are the patient?

Plenary III: Practical Evidence: Maximizing the use and usefulness of what we know Thursday 17 February 2011, 2:30 - 4 p.m.; Star Sapphire Ballroom “Knowledge, if it does not determine action, is dead to us.” Ancient Philosopher, Plotinus, 205 - 270 AD We may have all the answers in the world, but they are useless until we apply them into practice. There are many barriers to the application of best evidence and, therefore, we need to create the tools and conditions that facilitate its use and usefulness. Some barriers relate to time and access. For instance, busy providers don’t have time to sort through thousands of journals for the articles they need and then read the full article to glean the main messages. It is not realistic to expect this at point of care, during a 10 minute appointment with a patient. The next generation of health providers, as students, have a plethora of new knowledge coming their way every day. How do we ensure the culture of evidence is rooted in their minds, along with the skills to find and use it? Should we teach critical appraisal skills throughout the education system so that best evidence can be sought and found? And what about patients who need to be partners in their health care decisions? How do we make accessing reliable information they can use a reality for them? These will be explored during this plenary session

Dr Jeremy Grimshaw: Access to The Cochrane Library; results of a pilot license for Canada Alan Cassels: Evidence, the media and what the public hears; how to increase understanding and access to the best evidence Dr Ian Scott: Early exposure to the best evidence: Moving from the classroom to the exam room

Plenary II: Credibility of the Evidence: Are there gaps? Thursday 17 February 2011, 8:30 - 10 a.m.; Star Sapphire Ballroom “In the end, you make your reputation and you have your success based upon credibility and being able to provide people who are really hungry for information what they want.” American Journalist Brit Hume said this and it holds true for any type of information – with a suggested addendum, “. . . and what they need”. In the realm of health care decisions, credible information is a must. One of the highest level evidence is a welldesigned and implemented Randomized Controlled Trial (RCT),

Johanna Trimble: “Is Your Mom on Drugs? - Find out what to do about it” Bikaramjit Mann: Injecting practical aspects of evidence into education Dr Brian Haynes: Who needs to learn/teach/do critical appraisal when you have easy access to evidence-based summaries, synopses, syntheses, and studies?

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Meet our Speakers
Special Guest: Dr Penny Ballem, City Manager, Vancouver With more than 30 years of experience in senior management positions in the Canadian public sector, City Manager Dr Penny Ballem has extensive experience in managing large organizations, building relationships across private and public sectors, and collaborating with civic, provincial, and federal levels of government. Dr Ballem is trained as a clinical hematologist and has served as the deputy minister of Health for British Columbia, as well as the vice-president of Women’s and Family Health at the Children’s and Women’s Health Centre of BC. She also served as a corporate director for Bentall Capital G.P. Ltd., as well as a senior advisor to RPO Management Consultants. Plenary I: Accessing the Best Evidence Early Wednesday 16 February 2011, 8:45 - 10 a.m.; Star Sapphire Ballroom Dr Jeremy Grimshaw: Dr Grimshaw has more than 20 years of research and medical experience. He was recently elected as the co-chair of The Cochrane Collaboration Steering Group. He is also currently the Canada Research Chair in Health Knowledge Transfer and Uptake; senior scientist in the Clinical Epidemiology Program, Ottawa Hospital Research Institute; full professor, Department of Medicine, University of Ottawa; co-ordinating editor of the Cochrane Effective Practise and Organisation of Care Review Group; and director of the Canadian Cochrane Centre.

Alan Cassels: Alan Cassels has been immersed in pharmaceutical policy research for the past 16 years, primarily working on national and provincial studies of prescription benefit policies, and the effects of independent information on prescriber and consumer behaviour. His strong interest in the quality of health coverage has made him into one of Canada’s leading researchers on Canadian medical reporting. He has been awarded numerous research grants and has lectured widely on medical media in Canada, the US and Australia. He has frequently reported on consumer health issues for magazines, newspapers and the CBC Radio program IDEAS. His book, Selling Sickness: How the World’s Biggest Pharmaceutical Companies are Turning us All into Patients (co-written with Ray Moynihan) was an international bestseller. His second book, The ABC’s of Disease Mongering: An Epidemic in 26 letters, is an illustrated book of rhymes which one critic likened to “Dr. Seuss taking on an overmedicated and over-diagnosed culture.” Alan Cassels was awarded the 2010 University of Victoria School of Public Administration Alumni award for Exceptional Achievement.

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Cochrane Canada 9th Annual Symposium

Dr Ian Scott: Dr Scott is an Associate Professor in the Department of Family Practice at the University of British Columbia (UBC). He obtained his medical degree in 1991, his CCFP in 1993, his FRCPC in Community Medicine in 1997 and a Master’s in Health Research Methodology in 2008 from McMaster University. Prior to joining UBC he worked as a community HIV primary care physician. He joined UBC in 1999 as the Director of Undergraduate Family Practice Programs a position he continues to hold today. He is currently in a leadership role addressing curriculum renewal at UBC. His research has focused on medical education, particularly medical student career choice as well as lay health perceptions of marginalized women. He has published 20 articles in peer reviewed journals in these areas. At the national level, he serves as the Chair of the College of Family Physicians of Canada Undergraduate Education Office. He is married and has two children ages nine and 11. He has become comfortable with his son’s 6 a.m. hockey practices. Plenary II: Credibility of the Evidence: Are there gaps? Thursday 17 February 2011, 8:30 - 10 a.m.; Star Sapphire Ballroom Anita Palepu: Anita Palepu is a Professor of Medicine at the University of British Columbia and is active staff at St. Paul’s Hospital. Her research area is urban health and vulnerable populations. She is one of the founding editors of Open Medicine, an open-access, peer-reviewed general medical journal committed to academic freedom and an associate editor with the Annals of Internal Medicine. She is interested in increasing accessibility to high quality health research and how technology can be used to improve health research reporting.

Mark Petticrew: Mark Petticrew is Professor of Public Health Evaluation in the Department of Social and Environmental Health Research in the Faculty of Public Health and Policy at London School of Hygiene and Tropical Medicine. His research has involved primary research on the health effects of housing, urban regeneration, transport and employment interventions, and involves assessing the potential effects of such interventions on health inequalities. He has also worked on numerous systematic reviews of the effects on health and health inequalities of employment, housing, transport and tobacco control policies. He is one of the convenors of the Campbell and Cochrane Equity Methods Group, and is an editor of the Cochrane Public Health Review Group.

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Anne McFarlane: Anne McFarlane is currently the Vice President of Western Canada and Developmental Initiatives at the Canadian Institute for Health Information (CIHI). The Western Office is responsible for CIHI activities in the four western provinces and the three territories. CIHI offices in Western Canada are located in Victoria. Ms McFarlane holds an MSC in epidemiology and a MA in philosophy. She has 20 years experience in working in the Ministries of Health, Education, Finance and Social Services for the Governments of British Columbia and Saskatchewan. Her positions with the BC Ministry of Health included Assistant Deputy Minister responsible for Policy, Planning, Legislation and Intergovernmental Relations, Executive Financial Officer and Director of Pharmacare. Anne has served on the Medical Services Commission, the board of the Michael Smith Foundation for Health Research, the board of Providence Health Care, the board of the Canadian Institute of Health Services and Policy Research, the Funders’ Forum of The Cochrane Collaboration and has chaired the Federal-Provincial-Territorial Advisory Committee on Health Services (ACHS). She is currently a member of the Cochrane Canada Advisory Board and an Associate Member of the Centre for Health Services and Policy Research at UBC. Plenary III: Practical Evidence: Maximizing the use and usefulness of what we know Thursday 17 February 2011, 2:30 - 4 p.m.; Star Sapphire Ballroom Johanna Trimble: Johanna Trimble is a patient advocate and a member of the steering committee of the BC Patient Voices Network (PVN). She is actively involved at many levels in Shaping the System and Community Activation as a patient representative within PVN. She is also a member of Patients for Patient Safety Canada, a working group of the Canadian Patient Safety Institute. She won a ‘best poster’ award in 2010 at a medical conference in Amsterdam sponsored by the government of the Netherlands and the World Health Organization for her poster entitled: “Is Your Mom on Drugs?” Her primary interest in over-medication and care of the elderly is based on her experience with her own family. Her library and educational media background predispose her to compulsive researching.

Bikaramjit Mann: Bikaramjit Mann was born and raised in Duncan, British Columbia. After graduating from Cowichan Secondary School in 2002, he attended the University of British Columbia (UBC) and obtained a degree in pharmacy in 2007. During his undergraduate degree he had the good fortune of being introduced to the fundamentals of EBM including The Cochrane Collaboration. Currently, he is a fourth year UBC medical student who is interested in pursuing a career in internal medicine. In his spare time he enjoys reading, playing sports, martial arts, and spending time with his wonderful fiance.

Dr Brian Haynes: Brian Haynes is Professor of Clinical Epidemiology and Medicine, Chief of the Health Information Research Unit at McMaster University, and on the active medical staff of Hamilton Health Sciences, Hamilton, Ontario. His main research interests are in improving health and health care through enhancing the validation, distillation, dissemination and application of health care knowledge. He is one of the originators of evidence-based medicine and is fond of creating evidence-based resources such as ACP Journal Club, Evidence-Based Medicine, EvidenceUpdates, Nursing PLUS, Rehab PLUS, and KT+, as well as working tools for authors of evidence-based texts, systematic reviews and guidelines.

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Cochrane Canada 9th Annual Symposium

WORKSHOP Abstracts
Please note: The names of workshop presenters appear in bold. Workshop 1: Presenting the Results of Complex Reviews using Summary of Findings Tables (Accessible) Wednesday 16 February 2011, 10:30 a.m. - 12 p.m.; Star Sapphire Ballroom Alain Mayhew, Jeremy Grimshaw, Cochrane Effective Practice and Organisation of Care (EPOC) Group, Ottawa, Canada; Nancy Santesso, Holger Schünemann, Cochrane Applicability and Recommendations Methods Group, Hamilton, Canada. Learning objectives: 1) To understand the approach to producing Summary of Findings (SoF) tables for complex reviews. 2) To have a framework to create SoF tables for complex reviews. Description: Guidance to create SoF Tables is provided in the Cochrane Handbook for Systematic Reviews of Interventions and the GRADE handbook/GRADE profiler software. However, some Cochrane Reviews are complex with multiple heterogeneous interventions, a variety of study designs, different methods for synthesizing results (e.g. a range of effects, narrative synthesis), and diverse outcomes. This workshop includes an interactive plenary session and small group work to discuss the challenges of presenting results from complex reviews and potential solutions. A brief explanation of the purpose of and methods used to create SoF tables for Cochrane Reviews will be provided with more detail about how to present results for complex reviews. The presenters will share examples of reviews with SoF tables for complex reviews which incorporate risk of bias assessments, the use of GRADE to assess the quality of the body of evidence, and results from the analysis of the included studies. Participants will then break out into small groups creating a portion of an SoF table for a complex review. Participant Engagement: Participants will discuss the challenges of presenting results from complex interventions in plenary. In small groups, all participants will work with each other and a facilitator to create part of an SoF. Questions can be answered and discussed in these groups. Knowledge level required: Intermediate. Workshop 2: Don’t put the cart before the horse (Using the hierarchy of logical questioning for systematic reviews) (Credible) Wednesday 16 February 2011, 10:30 a.m. - 12 p.m.; Emerald A Aaron M Tejani, Vijaya Musini, Ken Bassett, Jim Wright, Ciprian Jauca, Cochrane Hypertension Review Group, Vancouver, Canada; Background: Several published Cochrane Reviews answer research questions that do not seem appropriate in the context of current knowledge. For example, is there any point in knowing which interventions increase influenza vaccination rates if there is no evidence that the vaccination leads to a significant reduction in morbidity and mortality? A simple framework known as the “hierarchy of logical questioning” can be used to deal with this dilemma. Objective: To describe how to identify the appropriate systematic review research questions by using the hierarchy of logical questioning framework. Methods: Several examples of recent reviews will be described that answer research questions which are presumptive/lack clinical importance in the context of current knowledge. In each case, an overview of current knowledge will be explored followed by the development of a hierarchy of logical questioning. The final step will be to identify what the appropriate research question should have been for each of the examples. In addition, the audience will be alerted to the possible negative consequences (e.g. increasing adherence to medications that lead to net harm) of conducting a systematic review in which the research question is presumptive/of limited clinical importance. Finally, the audience will be shown how to use the aforementioned framework in order to properly interpret systematic reviews that have already been conducted, in an effort to avoid being misled. Conclusions: By using the hierarchy of logical questioning researchers can produce more appropriate research questions and systematic reviews that would better serve knowledge users.

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Early Exposure to Cochrane: Accessible - Credible - Practical

Workshop 3: Connecting with Others: Putting Scoping Review Methodology into Action (Practical) Wednesday 16 February 2011, 10:30 a.m. - 12 p.m.; Jade Ballroom Susan Brien, Heather Dawson, Deborah Bourk, Health Council of Canada, Toronto, Canada. Learning objectives: To instruct participants on how to conduct a scoping review based on a methodology currently used by the Health Council of Canada to summarize and map existing knowledge and guide the planning and production of public reports. Description: Scoping reviews are a relatively new methodology for knowledge synthesis, designed to identify themes or areas of focus and also indicate where gaps in the knowledge exist in a particular topic area. Methods for scoping reviews have been published. However, these methods focus on scoping academic literature, and do not provide insight on how to use the information generated from scoping. The proposed workshop will be a practical presentation of methods used for scoping based on those described by Arksey and O’Malley (Int J Soc Res Meth 2005, 8(1): 19), but with greater involvement of stakeholders and content experts in the review and mapping of existing knowledge. The workshop will also address the next steps after scoping, in particular how knowledge products are used to guide report planning and production. Participant engagement: The workshop leaders will guide participants through the planning phases of a scoping review pertaining to a topic that is of interest to them either individually, or as a group. Tools developed and used by the Health Council of Canada will be shared with participants to assist them through a scoping review. At the end of the session, participants will have the knowledge foundation and plan for conducting a scoping review on their own. Knowledge level required: Introductory. Workshop 4: How to use GRADEpro software to create Summary of Findings Tables (Accessible) Wednesday 16 February 2011, 1 - 2:30 p.m.; Star Sapphire Ballroom Nancy Santesso, Holger Schünemann, Applicability and Recommendations Methods Group, McMaster University, Hamilton, Canada. Learning objectives: To learn to use the GRADEpro software to create Summary of Findings Tables. Description: Summary of Findings (SoF) tables are an important addition to Cochrane Reviews and Cochrane Review authors are strongly encouraged to include an SoF in their

reviews. GRADEpro is the software to create an SoF (as well as GRADE evidence profiles used in guideline development). The main feature of GRADEpro is to facilitate the assessment of the quality of evidence (study design/risks of bias, limitations, directness of evidence and sparseness of data) and to convert and summarize results of a review into relative and absolute effects for each outcome. This workshop takes participants through the entire process of creating an SoF using GRADEpro; it is hands-on. Participants will work on an example of a Cochrane Review or use their own review during the workshop. Participants will learn to import data from RevMan 5 to create an SoF. Each step or decision point of the process is explained and participants immediately practice it before moving to the next step. In addition to the presenter, other trainers are available throughout the workshop to help and support participants or provide more advanced information Participant engagement: Participants will need to bring their own laptop, a Cochrane review as a RevMan file (or work on the workshop example), and a downloaded copy of the GRADEpro software. Participants will be working on their own SoF for the entire workshop while the facilitator leads the group through the process. Knowledge level required: Introductory. Workshop 5: Investigating and Dealing with Bias in Systematic Reviews (Credible) Wednesday 16 February 2011, 1 - 2:30 p.m.; Emerald A Lucy Turner, David Moher, Ottawa Hospital Research Institute, Ottawa, Canada; Doug Altman, Oxford University, Oxford, UK; Jonathan, Sterne, Bristol University, Bristol, UK. Learning Objectives: The objective of this workshop is to provide an introduction to the different forms of biases and the methods that might be used to detect these biases. Description: The results of a systematic review can be distorted if bias has been introduced into the review process at any stage (e.g. biased location and selection of included studies, high risk of bias in the results of included studies). Accordingly, investigation of the presence, degree and the nature of bias is recommended as a routine part of the systematic review process. The Bias Methods Group draws together researchers interested in this field, and the new Cochrane Handbook for Systematic Reviews of Interventions contains chapters on “Addressing reporting biases” and “Assessing the risk of bias in included studies”. The workshop will largely draw upon the work of members of this group, of which the presenters are co-conveners or associated

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Cochrane Canada 9th Annual Symposium

parties. We will discuss potential biases which may be introduced into reviews, with an emphasis on reporting biases, and the effects of flaws in the methodology of component studies. Particular attention will be paid to publication bias (the publication, or non-publication of research findings, depending on the nature and direction of the results), other reporting biases including outcome selection biases, and the empirical evidence on sources of bias in the results of RCTs. We will demonstrate and discuss graphical and statistical methods that can be used to detect or investigate bias. Participants engagement: The workshop will consist of powerpoint presentations, and continual discussions with and among participants. With particular focus on issues which have arisen during risk of bias assessment. Knowledge level required: All levels. Workshop 6: Using Social Media to Promote Evidence-Based Practice: A Primer on Blogs, Wikis and Twitter (Practical) Wednesday 16 February 2011, 1 - 2:30 p.m.; Jade Ballroom Dean Giustini, School of Library, Archival, and Information Science, University of British Columbia, Vancouver, Canada; Francisco Grajales III, Western Regional Training Centre for Health Services Research, Vancouver, Canada; Daniel Hooker, eHealth Strategy Office, Faculty of Medicine, Vancouver, Canada. Background: This workshop provides an overview of three popular social media technologies, blogs, wikis and microblogging (e.g., Twitter, Yammer). The authors will show where to locate medical blogs and wikis on the social web and the type of information that can be found there to support evidence-based practice. Through a mix of didactic lecture, hands-on practice, and group discussion, this workshop provides an entry point for social media beginners. Learning objectives: At the end of this workshop, participants will:

new content and social networks

Be able to assess issues of privacy on various social media platforms Contextualize workshop information for personal use in practice, research and continuing education

Format: A practical session that combines lecture, live demonstrations and practical exercises. Equipment required: Participants can bring their laptops and mobiles. Internet access will be provided. Knowledge level required: Some awareness of social media and basic knowledge of the web. Workshop 7: How to use the GRADE approach to assess the quality of the evidence in systematic reviews (Accessible) Wednesday 16 February 2011, 3 - 4:15 p.m.; Star Sapphire Ballroom Holger Schünemann, Nancy Santesso, Applicability and Recommendations Methods Group, McMaster University, Hamilton, Canada. Learning objectives: 1) To understand the overall GRADE approach and how the assessment of the evidence fits in. 2) To understand and apply the GRADE criteria to assess the quality of evidence from systematic reviews. Description: The GRADE approach is being used to develop guidelines and includes the assessment of the quality of evidence from a systematic review of the literature and using that evidence to make recommendations. Part of this process is using GRADE to produce a summary of the evidence. Authors of Cochrane Reviews can create a Summary of Findings Tables to present the key findings of their review and the quality of the evidence using GRADE. This interactive workshop encourages participants to discuss the concepts underlying GRADE. In particular, the eight criteria of GRADE to assess the quality of the evidence will be discussed, including risk of bias, inconsistency, indirectness, imprecision, publication bias, large effects, lack of confounding, and dose response. In addition, the presentation of the results in a table will be addressed. Participant engagement: Participants will be required to participate in an interactive plenary session and discuss issues in small groups. Participants will discuss and create the GRADE framework and a Summary of Findings Table during the session. Knowledge level required: Introductory.

Understand blog, wiki and microblogging tools and how they are used in medicine Have some basic knowledge of how to select one of the social tools examined to support evidence-based practice and medical education Identify major blogging and wiki platforms to create accounts,

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Early Exposure to Cochrane: Accessible - Credible - Practical

Workshop 8: Dealing with heterogeneity in metaanalysis (Credible) Wednesday 16 February 2011, 3 - 4:15 p.m.; Emerald A Joseph Beyene, Statistical Methods Group, Toronto, Canada. Learning objectives: To provide review authors with the knowledge to understand and investigate variability across studies in a meta-analysis, and to recognize the limitations of the methods available. Description: This training workshop will address approaches to dealing with between-study variability, or heterogeneity, in the results of a series of studies. We first will discuss some potential sources of between-study variability, and overview some methods for identifying whether heterogeneity poses a problem in a particular set of studies. We then will focus on issues related to dealing with study variability once it has been identified. In particular, we will discuss the decision whether or not to combine results; the choice between fixed and random-effects analyses; and the use of subgroup analyses and meta-regression. Participant engagement: Through interactive questions and answers Knowledge level required: Intermediate. Workshop 9: Logic Models: Mapping Complex Interventions (Practical) Wednesday 16 February 2011, 3 - 4:15 p.m.; Jade Ballroom Erin Ueffing, Peter Tugwell, Campbell and Cochrane Equity Methods Group, University of Ottawa, Ottawa, Canada; Laurie Anderson, Washington State Institute for Public Policy, Olympia, USA; Rebecca Armstrong, University of Melbourne, Melbourne, Australia; Philip Baker, Daniel Francis, QLD Health, Brisbane, Australia; Mark Petticrew, London School of Hygiene and Tropical Medicine, London, UK; Eva Rehfuess, University of Munich, Munich, Germany. Learning objectives: Participants will learn how visual tools can help shape their reviews. Description: The methods for evaluating complex interventions are still being debated and argued. Moreover, the role and value of theory in systematic reviews are sometimes contested. Logic models describing mechanisms of action, with consideration of context and policy/social/cultural environments, are one method of including theory. Analytic frameworks, with their map of relationships and outcomes, are also useful for critiquing linkages in evidence in systematic reviews. We propose a hybrid for systematic reviews of complex interventions: a map in which detailed pathways for effectiveness are embedded in a broader picture. Participant engagement: Participants are invited to bring their

review topics for discussion in small working groups; audience interaction will be encouraged. Examples from Cochrane Reviews and clinical and public health guidelines will be shared. Knowledge level required: Intermediate. Workshop 10: Reference Management for Systematic Reviews (Credible) Thursday 17 February 2011, 10:30 - 11:45 a.m.; Star Sapphire Ballroom Michelle Fiander, Cochrane Effective Practice and Organisation of Care (EPOC) Review Group, Ottawa, Canada; Douglas M Salzwedel, Cochrane Hypertension Review Group, Vancouver, Canada. Systematic Reviews (SRs) entail the identification and screening of thousands of citations from multiple sources. Despite this volume, strategies for data management are often developed ad hoc, an approach which may lead to inconsistency, duplication of effort, and reduced transparency such as loss of data to support PRISMA, or to report reproducible search strategies. This workshop will demonstrate tools, outline strategies, and offer guidance to support participants’ development of a reference management plan for SRs. Topics: 1) Overview of software (Reference Manager, EndNote), with emphasis on database customization, reference coding, and managing duplicates. 2) File management, e.g. file naming, folder organization. 3) Use of import and export filters for data from PubMed, OVID Medline, etc. 4) Migrating data to Cochrane’s RevMan software. Instructors will demonstrate software and processes. Test exercises will be provided or participants may consider examples from their own work. Instructors will circulate among participants to support experimentation and testing. Knowledge/Technology: Participants will be asked to be familiar with Reference Manager or EndNote and to bring laptops loaded with reference management software.

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Cochrane Canada 9th Annual Symposium

Workshop 11: Real patient video can illustrate the use of Cochrane Systematic Reviews (Practical) Thursday 17 February 2011, 10:30 - 11:45 a.m.; Jade Ballroom Thomas L. Perry, Barbara Mintzes, Aaron Tejani, Colin Dormuth, Vijaya Musini, Ciprian Jauca; Sandy Shamon, Billy Lin, Blair Fulton, Bikaramjit Mann. Learning objectives: see below. Description: Prescribers’ knowledge about drug effects diminishes even as the number of licensed drugs increases dramatically. Polypharmacy is becoming ubiquitous - many older Canadians take more than 12 systemically active prescription drugs. What might seem absurd to an external observer is now “normal” to patient, doctor, and pharmacist. No one can predict the possible interactions and pharmacological effects of such combinations on an individual patient, while at population level RCT evidence is not relevant to short or long term effects on human beings. Most Canadian medical students and doctors are not comfortable using Cochrane Reviews, likely preferring ultraconvenient resources such as UpToDate or guidelines. How can we make Cochrane Reviews more relevant to their needs, and awaken students and doctors to the clinical utility of reliable evidence? Real patients telling their own stories can open prescribers’ minds to the harm as well as benefit caused by drugs. Video technology could enhance utility and utilization of Cochrane Reviews. Dramatic personal accounts could stimulate important clinical questions for future Cochrane reviewers (e.g. how best to treat pain, how long to continue preventive treatments). Participant engagement: We will link Cochrane Review evidence to video cases which elucidate the practical implications of “evidence”. Participants will debate how quality of systematic reviews might be improved if authors understand from clinical examples how “evidence” derived from RCT group mean outcomes can affect the lives of our fellow citizens for worse as well as for better. Knowledge level required: Suitable for anyone who has ever taken a drug or written a prescription and who wants Cochrane Reviews to be useful to health professionals and public. This workshop will be highly interactive.

Workshop 12: The reality of rapid reviews (Practical) Thursday 17 February 2011, 10:30 - 11:45 a.m.; Emerald A Kristin Konnyu, Chantelle Garritty, David Moher, Jeremy Grimshaw, Ottawa Hospital Research Institute, Ottawa, Canada; Rob Cushman, Champlain Local Health Integration Network, Ottawa, Canada. Learning objectives: 1) To develop an understanding of the need for, and utility of, rapid review-type products; 2) To develop an appreciation of the scope of rapid review-type products produced to date and their underlying methodology; 3) To explore the specific strengths/weaknesses, do’s/do-not’s that have emerged from our experiences in providing a rapid review service as part of a local researcher/decision maker collaboration. Description: Rapid reviews are increasingly being employed as a research tool to support evidence-informed decision making in a timely manner. Despite their growing utilization, there exists no universal consensus on how rapid reviews should be defined, executed, or utilized. The aim of this workshop is to describe the current landscape of rapid reviews and drawing from panel experiences, help attendees understand practical issues and approaches involved their execution. The workshop panel will bring together the perspectives of researchers, policy/decision makers, and program managers, thus focusing the dialogue to pragmatic and practical issues pertinent in the execution of rapid reviews. The suitability of a rapid review-type platform for Cochrane Canada will also be explored. Participant engagement: Participants will be divided into groups (six - eight) comprising two entities: the office of the CEO of a health authority; and the rapid review team. Both will be presented with an emergent health issue that requires a decision within six weeks and asked to delineate an appropriate rapid approach to address the issue from their respective perspectives. Knowledge Level Required: Introductory. Workshop 13: Selecting Studies for Inclusion in a Review: Not an Easy Task (Accessible) Thursday 17 February 2011, 12:30 - 2 p.m.; Star Sapphire Ballroom Donna Moralejo, School of Nursing, Memorial University, St. John’s, Canada; Alain Mayhew, Jeremy Grimshaw, Cochrane Effective Practice and Organisation of Care (EPOC) Group, University of Ottawa, Ottawa, Canada; Dinah Gould, School of Community and Health Sciences, City University, London, UK. Background: The Cochrane Effective Practice and Organisation of Care (EPOC) Group produces reviews addressing behavior

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Early Exposure to Cochrane: Accessible - Credible - Practical

change of health care providers (HCPs). One such behaviour is hand hygiene, which has been identified as a key method of reducing the spread of infection among HCPs and patients. Although facilities are adopting interventions to influence HCP hand hygiene, there remains a serious lack of knowledge about the effectiveness of the interventions. Although EPOC reviews can include some non-randomized designs, few of the studies conducted to evaluate hand hygiene interventions could be included in an EPOC review because of limitations in their methodology. Objectives: To review the criteria and process for selection of studies to include in a review. To identify limitations of published reports of interventions to change hand hygiene behaviour. Methods: Some included and excluded studies of a recently updated Cochrane Effective Practice and Organisation of Care Group review (Gould et al, 2010) will be used as an example to work through the process. Participants will be provided with inclusion criteria and asked to appraise the studies for inclusion in the review. Some of the topics for discussion will include eligible populations, study design criteria, appropriate outcomes for inclusion, use of proxy measures and appropriate control groups. A very basic description of analysis methods will be presented; however the focus of the workshop will be on inclusion criteria and selection process. Knowledge level required: Introductory. Workshop 14: To whom does the evidence apply? Addressing sex and gender to enhance the credibility of systematic reviews (Credible) Thursday 17 February 2011, 12:30 - 2 p.m.; Pearl Room (Level 2) Marion Doull, School of Population and Public Health, University of British Columbia, Vancouver, Canada; Madeline Boscoe, REACH Community Health Centre, Vancouver, Canada; Barbara Mintzes, Department Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada; Sari Tudiver, Researcher/Writer on Gender and Health, Ottawa, Canada (Co-facilitator). Learning objectives: 1) Enable participants to identify the rationale for and the challenges of specifying to whom the evidence applies in systematic reviews, with a major focus on sex/gender-based analysis (SGBA); 2) Introduce a revised sex/gender appraisal tool for systematic reviews and seek feedback about its usefulness; 3) Encourage awareness about methodologies and tools relevant to SGBA, equity analysis, quality assessment and identifying bias in systematic reviews to enhance the collection, synthesis and analysis of credible evidence for decision-making.

Description: Systematic reviews are designed to evaluate the effectiveness of interventions in health and policy by gathering and analyzing evidence from multiple primary studies. However, reviews can be subject to many types of omission and bias, including not clearly specifying to whom the evidence applies. This omission has implications for the quality of research, of evidence-based policy and practice and for achieving equitable health outcomes for women and men. It also presents challenges for knowledge transfer and risk assessments. The workshop will address why sex/gender matter in systematic reviews of health interventions and how SGBA can enhance the credibility of systematic reviews. SGBA will be discussed in the context of other relevant approaches and tools, including equity analysis that seek to improve the quality and applicability of systematic reviews in health to diverse population groups. Participant engagement: Will occur through presentations of case examples, opportunity for critical dialogue and a small group exercise where participants will be asked to assess whether a primary study or review protocol clearly identifies to whom the evidence applies with particular attention to sex/ gender. Oral and written feedback will be sought. Knowledge level required: None. Workshop 15: Extrapolation: Applying the results from systematic reviews to whom, when, and how? (Practical) Thursday 17 February 2011, 12:30 - 2 p.m.; Jade Ballroom Mark Petticrew, Gemma Phillips, London School of Hygiene and Tropical Medicine, London, UK; Mike Clarke, UK Cochrane Centre, Oxford, UK; Russell Gruen, Monash University, Melbourne, Australia; Gordon Guyatt, McMaster University, Hamilton, Canada; Elizabeth Kristjansson, Peter Tugwell, Erin Ueffing, Vivian Welch, University of Ottawa, Ottawa, Canada; Shawna Mercer, US Centers for Disease Control and Prevention, Atlanta, USA. Learning objectives: To test a new extrapolation checklist with participants; to provide participants with a tool for decisionmaking. To debate methodological concerns around equity and systematic reviews. Description: There is a need for guidance on how policymakers, clinicians, public health practitioners, and the public can apply the results from Campbell and Cochrane Reviews to disadvantaged groups. The question that these stakeholders have is really, “In my setting/population, will this intervention produce the same results as those from the systematic review and/or trials?”

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Cochrane Canada 9th Annual Symposium

We proposed to help researchers, practitioners, and policymakers using Cochrane and Campbell Reviews by giving them guidance on this – such as by applying a simple scale for groups of interest. We then conducted a pilot exercise using a checklist with Cochrane leaders. We are now revising the checklist and developing testing scenarios; these scenarios are reflective of different settings and populations globally using selected factors from the “PROGRESS-Plus” framework (Place of Residence; Race/Ethnicity; Occupation; Gender; Religion; Education; Socioeconomic Status; and Social Capital, with “PLUS” representing additional axes including age, sexual orientation, and disability). Participant engagement: Introductions; participants will apply the checklist individually to testing scenarios; breakout groups (discussion on experience with testing scenarios and checklist); report back in plenary. Knowledge level required: Intermediate. Workshop 16: How can we make sense of Cochrane Reviews of complex interventions? Consideration of 3 complementary synthesis methods (realist review, meta-narrative, metaethnography) to better understand the ‘how’ and ‘why’ of findings (Practical) Thursday 17 February 2011, 12:30 - 2 p.m.; Emerald A Monika Kastner, Andrea C Tricco, Sharon E Straus, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada. Learning objectives: To discuss the challenges of conducting systematic reviews of complex interventions in healthcare, and to provide participants with an overview of three different qualitative review methods that may overcome these challenges (realist review, meta-narrative synthesis, and meta-ethnography), including how they can be used to contextualize findings from Cochrane Reviews of complex interventions. Description: The workshop will consist of three 10-minute presentations on each synthesis method (with three-five minutes for questions after each presentation), followed by a 30-minute small-group workshop. Each presentation will provide the following information: 1. Brief background and definition of the review method 2. Overview of the methods for conducting the review 3. Applicability of the review method to healthcare intervention

topics from Cochrane Reviews 4. Challenges of conducting the review method 5. ‘How-to’ tips on conducting the review Participant engagement: Participants will be divided into three groups, and asked to read one of three research questions from a clinical or health services research discipline. The questions will be formulated using barriers identified from the literature and with input from clinicians and researchers. Participants will be asked to discuss how they would address the research question using one of the three review methods, outline a plan for investigating the problem, and provide a rationale for their plan (10-15 minutes). As a supplement to the discussion, participants will be given a “hand-out” describing the three review methods. A representative from each group will present their plan to the large group to facilitate further discussion. Knowledge level required: Introductory/intermediate.

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Early Exposure to Cochrane: Accessible - Credible - Practical

ORAL Abstracts
Please note: The names of oral presenters appear in bold.

Oral Session 1: Practical
Moderator: Vijaya Musini Wednesday 16 February 2011; 10:30 a.m. - 12 p.m.; Pearl Room (Level 2) Salivary and oral fluid based HIV antibody assays for rapid diagnosis of HIV infection Bhairavi Balram, Nitika Pant Pai, McGill University Health Centre, Montreal, Canada; Rosanna Peeling, London School of Hygiene and Tropical Medicine, London, UK. Background: Convenient and non-invasive, salivary and oral mucosal transudate (OMT) based rapid HIV tests offer potential to expedite timely screening for HIV of at risk populations worldwide. However, a systematic appraisal of their performance is lacking. Objectives: To evaluate the diagnostic performance of all salivary and OMT based HIV tests. Methods: Two reviewers independently searched five worldwide electronic databases (CINAHL, EMBASE, BIOSIS, Web of Science and MEDLINE); for the period January 1986 - July 2010, abstracted data, and critiqued quality of 67 studies. Heterogeneity was explored in forest plots; SROC plots generated and random effects bi-variate regression (BVR) analyses conducted for select subgroups. Results: A total of 67 studies were published worldwide, sample sizes ranging from 37-24,347. Significant heterogeneity (chi square p<0.05) present was attributed to various study settings, at risk populations, and evolving reference standards. Pooled diagnostic accuracies generated with BVR for select samples/ devices were: 1) Saliva, Sensitivity, (Sn) 99.36% (95%CI: 98.11, 99.78), Specificity (Sp) 99.58% (95%CI: 98.46, 99.89), 2) Salivette, 99.37% (95%CI: 95.24, 99.92), 99.88% (95%CI: 97.25, 99.99), 3) Omnisal, 99.31% (95%CI: 98.00, 99.76), 99.81% (95%CI: 99.64, 99.90), 4) Orasure, 99.12% (95%CI: 97.08, 99.74), 99.73% (95%CI: 98.80, 99.94), 5) OraQuick, 98.16% (95%CI: 95.74, 99.22), 99.82% (95%CI: 99.55, 99.93). Differential verification bias was found in 41 per cent and blinding was not reported in 70 per cent of studies.

Conclusions: Pooled sensitivity and specificity of all salivary and OMT tests were comparable and fairly high. Data provide strong evidence for their enhanced uptake in the recently expanded global HIV screening initiatives. Does Age Moderate CBT Treatment Effects in Child and Adolescent Anxiety?: Results from an Individual Patient Data Meta-Analysis Kathryn Bennett, Stephen Walter, Natalia Diaz-Granados, McMaster University, Hamilton, Canada; Katharina Manassis, The Hospital for Sick Children, Toronto, Canada; Amy Cheung, Sunnybrook Health Sciences Centre, Toronto, Canada; Pamela Wilansky-Traynor, Ontario Shores Centre for Mental Health Sciences, Whitby, Canada; Stephanie Duda, McMaster University, Hamilton, Canada, and the Adolescent Anxiety Collaborative Group. Background: Numerous randomized trials (RCTs) demonstrate the efficacy of cognitive behavioral therapy (CBT) in child and adolescent anxiety. However, critical questions remain regarding moderators of treatment effect, particularly patient age because CBT protocols were developed for use with those under age 12 and may be developmentally inappropriate for adolescents. Objective: To conduct an individual patient data meta-analysis (IPD – MA) to answer the question: Does age moderate CBT effect size as measured by a clinically and statistically significant interaction between age and the effect of CBT exposure? Methods: We identified all English language RCTs of CBT for anxiety disorders in those aged six to 19 using systematic review methods. Investigators of eligible trials were invited to submit their data for inclusion in our IPD-MA. The Anxiety Disorder Interview Schedule (ADIS) diagnostic severity score was our primary outcome measure. Age effects were investigated in four developmental age groups (six to seven; eight to 11; 12 to 15; 16 to 19). Multi-level modeling was used to account for data clustering within studies, and to assess study level random effects. Results: No statistically significant interaction between age and the effect of CBT exposure was found in a model containing age, sex, ADIS baseline severity score, and co-morbid depression diagnosis. Sensitivity analyses revealed this result to be robust. Conclusions: When adolescents receive CBT from expert clinicians in resource intensive settings they appear to benefit

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Cochrane Canada 9th Annual Symposium

at a level similar to younger children. Informal CBT protocol modification by these expert therapists may explain the absence of age effects in efficacy RCTs. However, there is still value in the development of adolescent CBT protocols to support the transportability of CBT effects to usual care settings which is not yet established. Smart-testing of blood glucose: The road from evidence to practice change in British Columbia (BC) Sarah Jennings, Aileen Mira, Jesmina Biserovic, Dorothy Li, Mitch Moneo, Brett Wilmer, Sophia Shin, Paul Mochrie, Suzanne Taylor, Bob Nakagawa, Pharmaceutical Services Division, BC Ministry of Health Services, New Westminster and Victoria, BC, Canada. Background: The use of blood glucose test strips by people with diabetes, not treated with insulin, costs BC PharmaCare about $11.8 million per year. The recent recommendations from the Canadian Agency for Drugs and Technologies in Health (CADTH) regarding unnecessary routine self-monitoring of blood glucose (SMBG) in this population is an opportunity to maintain health outcomes while enhancing sustainability of the health care system. Objective: Implement a SMBG knowledge translation strategy that helps bring evidence into practice and improves health care system sustainability in BC. Methods: Stakeholder meetings with participation from the Canadian Diabetes Association (CDA) and CADTH were held to determine current local values, beliefs, and ideas. A multi-faceted education plan was designed and approved. It incorporates CADTH implementation tools (animated shorts, alternate prescription pads, posters, prescribing aids and other selfmanagement tools); low- and no-cost partnership opportunities such as Education for Quality Improvement in Patient Care interventions, Ministry of Health Services newsletters, college and association journal articles, e-blasts and website postings; as well as presentations including webinars, live sessions for key target audiences of diabetes educators, other health care professionals, patients and public; and networking with diabetes education centres and health authority home and community care programs. Results: The accepted education plan focuses on ‘smarttesting’ and comprehensive diabetes management and uses a multifaceted approach to behavioural change. Development,

integration, implementation, and plans for evaluation of the education plan will be shared. Conclusions: The SMBG education plan incorporates an approach that is accessible, credible, and practical. Computerized clinical decision support systems for chronic disease management: A decision-maker-researcher partnership systematic review. Pavel S Roshanov, Health Research Methodology Program, McMaster University, Hamilton, Canada; Shikha Misra, Bachelor of Health Science Program, McMaster University (currently a medical student at the University of Toronto), Hamilton, Canada; Hertzel C Gerstein, Rolf J Sebaldt, Department of Medicine, McMaster University, Hamilton, Canada; Hamilton Health Sciences, Hamilton, Canada; Amit X Garg, Department of Medicine, Department of Epidemiology and Biostatistics, University of Western Ontario, London, Canada; Jean A Mackay, Lorraine Weise-Kelly, Tamara Navarro, Nancy L Wilczynski, Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; R Brian Haynes, Department of Medicine, McMaster University, Hamilton, Canada; Hamilton Health Sciences, Hamilton, Canada; Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; for the CCDSS Systematic Review Team. Background: Despite decades of research on computerized clinical decision support systems (CCDSSs), results from rigorous evaluations remain mixed and little is known about what makes an effective system. Previous systematic reviews seeking characteristics important for success were limited by small sample sizes and poor quality of primary studies. Objective: To determine if CCDSSs are effective at improving care processes or patient outcomes, and to identify characteristics associated with effectiveness. Methods: A systematic review of randomized trials comparing use of CCDSSs to usual practice or non-CCDSS controls in clinical care settings. We conducted literature searches to January 2010 in bibliographic databases and scanned reference lists. Guided by partnerships with clinicians and senior hospital administrators, we considered over 50 trial and system characteristics. Authors of all included primary studies were contacted to provide additional information and to help select features potentially associated with effectiveness. Two outcome categories were analyzed independently: ‘process of care outcomes’ (such as appropriate monitoring of disease) and ‘patient outcomes’ (such as values of test results). Results: In the 166 included trials, success rates for process of care and patient outcomes averaged 60% and 24%, respectively,

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Early Exposure to Cochrane: Accessible - Credible - Practical

across six categories of application: toxic drug monitoring and dosing, acute care, primary preventive care, chronic disease management, diagnostic test ordering, and drug prescribing. We will use univariate and multivariate analyses to identify features significantly associated with effectiveness. Conclusions: CCDSSs affect the process of care but have limited benefit for patients. Our analysis will provide empirical guidance on effectiveness, optimal design and implementation.

participation. Methods: We developed a search strategy on peer support and chronic disease and searched several databases. Abstracts were screened, relevant articles retrieved, independently scored for relevance, and assessed for quality. Using metaethnography, we identified key concepts within each study, and are currently translating these across studies to determine their relationship. A conceptual model to account for key analytical metaphors across papers is the intended outcome. Results: Twenty-one thousand, four hundred and eighty-nine abstracts across six chronic diseases (cancer, HIV, CVD, asthma, arthritis, diabetes) were identified. One thousand, four hundred and twelve abstracts were selected for full-length review. Fifty-eight articles were subjected to quality assessment, of which 25 were included in the meta-ethnography. Conclusions: While informing the development of a peer support program for individuals with EIA, this research will also provide a model that is transferable to other healthcare settings. This meta-ethnography is being considered for inclusion in The Cochrane Library as a standalone qualitative synthesis. An empirical study using permutation based resampling in meta-regression Joel Gagnier, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, U.S.; Claire Bombardier, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada; Health-Policy Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada; Heather Boon, Health-Policy Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada; David Moher, Clinical Epidemiology Methods Centre, Ottawa Health Research Institute The Ottawa Hospital, Ottawa, Canada; Joseph Beyene, Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, anada. Background: In meta-analyses, as the number of trials in the primary analyses decreases, the risk of false positives or false negatives increases. The same is true for meta-regression in multiple subgroup analyses. This is due to the assumption of normality which may not hold in small samples. Creation of a distribution from the observed trials using permutation and bootstrap methods to calculate p-values and confidence intervals may allow for less spurious findings. Objectives: To perform an empirical study to explore the differences in results for meta-analyses on a small number

Oral Session 2: Credible
Moderator: Ciprian Jauca Wednesday 16 February 2011; 10:30 a.m. - 12 p.m.; Emerald B&C Using meta-ethnography to develop a conceptual model on the perceived impact and experience of participating in peer support interventions Gayathri Embuldeniya, Emma Bell, Sharron Sandhu, Paula Veinot, Division of Rheumatology, Sunnybrook Health Sciences Centre, Toronto, Canada; Jennifer Boyle, Sydney Lineker, Ruth Tonon. The Arthritis Society - Ontario Division, Toronto, Canada; Nicky Britten, The University of Exeter, Exeter, UK; Joyce NyhofYoung, Faculty of Medicine, University of Toronto, Toronto, Canada; Wilson Centre for Research in Education, University Health Network, Toronto, Canada; Tom Raic, Bermuda Hospitals Board, Hamilton, Bermuda; Dawn Richards, Canadian Arthritis Network Consumer Advisory Council, Toronto, Ontario; Joanna Sale, Department of Health Policy, University of Toronto, Toronto, Canada; St. Michael’s Hospital, Toronto, Canada; Jenny Shu, University of Western Ontario, London, Canada; Chris Tran, University of Toronto, Toronto, Canada; Peter Tugwell, Community Medicine, Institute of Population Health, University of Ottawa; Rheumatology, Ottawa General Hospital, Ottawa, Canada; Mary J. Bell, University of Toronto, Toronto, Canada, Division of Rheumatology, Sunnybrook Health Sciences Centre, Toronto, Canada . Background: Peer support is proposed as an adjunct to clinical care and an instrumental part of assisting individuals with EIA to manage their disease. Meta-ethnography is being used to synthesize relevant qualitative studies while preserving their contextual integrity. The meta-ethnography will guide the development of a peer support intervention for early inflammatory arthritis (EIA). Objectives: Our aim is to develop a conceptual model explaining the perceived impact and experience of participating in peer support interventions. We examine factors that shape the experience and implementation of peer support interventions, and stakeholders’ views of the relations between specific characteristics of interventions and outcomes of intervention

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of trials using standard large sample approaches verses permutation and bootstrap based methods. Methods: We isolated a sample of randomized controlled clinical trials (RCTs) for interventions that have a small number of trials (herbal medicine trials). Trials were then grouped by herbal species and condition and assessed for methodological quality using the Jadad scale and data were extracted for each outcome. Finally we performed meta-analyses on the primary outcome of each group of trials and meta-regression with backwards elimination for a selection of variables within each meta-analysis. We used standard meta-regression methods and permutation methods to arrive at p-values and for choices during stepwise elimination. We then compared final models and and p-values between methods. Results: We collected 110 trials across five intervention/ outcome pairings and five-10 trials per covariate. When using permutation based resampling resultant p-values for significant covariates were larger 67 per cent of the time. All elimination results are being completed and will be presented. Conclusions: From these preliminary results permutation based resampling should be used to obtain p-values in metaregression of multiple covariates for relatively small amount of trials. Equity in Systematic Reviews: New Guidance for Review Authors Jordi Pardo Pardo, Peter Tugwell, Elizabeth Kristjansson, Vivian Welch, Erin Ueffing, University of Ottawa, Ottawa, Canada; Mark Petticrew, London School of Hygiene and Tropical Medicine, London, UK; Elizabeth Waters, University of Melbourne, Melbourne, Australia; Josiane Bonnefoy, University of Chile, Santiago, Chile; Antony Morgan, Emma Doohan, Michael P Kelly, National Institute for Health and Clinical Excellence, London, UK. Objective: To improve the synthesis of evidence relevant to reducing health inequities by identifying crucial equity components of a systematic review; to develop guidance for systematic review authors and other stakeholders who aim to synthesize evidence relevant for health equality and health equity. Methods: The Campbell and Cochrane Equity Methods Group collaborated with the World Health Organization’s Commission on Social Determinants of Health Measurement and Evidence

Knowledge Network. We consulted with experts in systematic reviews, health equity, and the social determinants of health to develop recommendations. We used systematic reviews from the Cochrane and Campbell Collaborations to illustrate how these recommendations can be applied. Results: We identified crucial components for equity-relevant systematic reviews. The seven main components were: 1) developing a logic model; 2) defining disadvantage and for whom interventions are intended; 3) deciding on the appropriate study design(s); 4) identifying outcomes of interest; 5) process evaluation and understanding context; 6) analyzing and presenting data; and 7) judging the applicability of results. We have created an ‘Equity Checklist’ that reflects these components. Conclusions: Our updated ‘Equity Checklist’ and these components give clear guidance on addressing equity in systematic reviews and will enable evidence users and creators to improve the evidence base on what works to reduce health inequities. Sex- and gender-based analyses in systematic reviews: methods and lessons learned for Cochrane Erin Ueffing, Cornelia M. Borkhoff, Elizabeth Kristjansson, Jordi Pardo Pardo, Peter Tugwell, Vivian Welch, University of Ottawa, Ottawa, Canada; Mark Petticrew, London School of Hygiene and Tropical Medicine, London, UK. Background: The Canadian Institutes of Health Research (CIHR) notes that “Accounting for gender and sex in health research has the potential to make health research more just, more rigorous and more useful.” As awareness around equity and justice issues grows, formal sex and gender policies have been established. For example, CIHR-funded researchers must address sex and gender, as appropriate, when designing their research, while the American National Institutes of Health (NIH) guidelines require funded clinical research to examine differential effects of interventions by sex/gender and race/ethnicity. Objectives: To report on findings from studies evaluating the degree to which systematic reviews, particularly those published by The Cochrane Collaboration, have addressed sex and gender. To describe how methods developed by the Campbell and Cochrane Equity Methods Group and colleagues can be used for sex- and gender-based reporting and analyses. Methods: We have published guidance on how to address equity and the social determinants of health in systematic reviews. Our methods include logic models, subgroup analyses, and process evaluations; sex and gender considerations are crucial for each of these methods.

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Results: We will provide an overview of how sex- and genderbased analyses can be included in systematic reviews. Specific methods for systematic reviews will be covered, with examples from Cochrane Reviews, the US Task Force on Community Preventive Services, and the Canadian Guidelines on Immigrant and Refugee Health. Conclusions: Sex- and gender-based analyses can help researchers ensure: 1) systematic reviews are suitably designed; 2) results from systematic reviews are available for men and women, males and females where appropriate; and 3) policies and decisions based on systematic review evidence are just and relevant.

Oral Session 4: Accessible
Wednesday 16 February 2011; 1 - 2:30 p.m.; Pearl Room (Level 2) Moderator: Anne McFarlane Collaborative development of capacity development workshops to promote local evidence-informed decision making Kara DeCorby, Maureen Dobbins, Lori Greco, Paula Robeson, Health Evidence, McMaster University, Hamilton, Canada. Background: Health Evidence (HE) is dedicated to a public health workforce whose decisions are informed by the best available evidence. To facilitate evidence-informed public health decision making HE provides: access to synthesized research evidence and supporting resources; and, tailored, customized knowledge-brokering services. In 2009, the National Collaborating Centre for Methods and Tools (NCCMT) funded a series of evidence-informed decision making (EIDM) workshops to public health decision makers. Objectives: To develop, deliver, and evaluate practical, interactive EIDM capacity-building workshops for public health decision makers in order to increase knowledge and skill to understand and locally adapt and apply, high-quality evidence in public health programming and policy. Methods: As NCCMT previously facilitated EIDM workshops in eastern Ontario, health units (HUs) were recruited in nearnorth, central, and southwest Ontario. Workshop curriculum was based on the Evidence-Informed Public Health framework (NCCMT, 2009) and was customized for local use through extensive consultation with each of the host HUs. Host HUs invited surrounding HUs to participate. Four one-day workshops were facilitated by three Health Evidence team members. Results: Of six HUs invited to host, four agreed. Sixty-five per cent of 137 workshop participants (86 per cent workshop capacity) from 16 (59 per cent) participating HUs returned evaluations. Conclusions: Collaborating with HUs in the development of tailored workshops promoted local interest, relevance, and uptake. Workshop content and the tailoring process will be presented. Evaluation results and lessons learned relevant to organizations providing EIDM workshops as well as public health organizations interested in EIDM capacity development will be highlighted.

Oral Session 3: Accessible
Wednesday 16 February 2011; 10:30 a.m. - 12 p.m.; Topaz Room (Level 2) Moderator: Eileen Vilis Everything you ever wanted to know about consumer involvement in Cochrane Panel: Catherine McIlwain, Consumer Coordinator, Cochrane Collaboration, Esher, UK; Elizabeth (Liz) Whamond, Cochrane Consumer Network (CCNet) Representative, Fredericton, New Brunswick; Mary Brachaniec, Consumer author and contributor to the Cochrane Musculoskeletal Group, Moncton, New Brunswick; Anne Lyddiatt, Consumer Editor for the Cochrane Musculoskeletal Group, Ingersoll, Ontario. Panel Discussion: These four consumer leaders will share their individual experience, vision and involvement in The Cochrane Collaboration. The panel discussion will provide information and stimulate discussion about how individuals bring an important perspective, have become connected and are contributing to The Cochrane Collaboration and Cochrane Reviews. The interaction (knowledge translation) between researchers and consumers has facilitated the use of research in decisionmaking. Past consumer activities have included priority-setting exercises which assist with new topic choices for reviews, commenting on and peer reviewing of systematic reviews and protocols, developing plain language summaries and decision aids for patients, and promoting systematic reviews to local contacts. The enthusiasm and involvement of consumers in Cochrane has led to new consumer-driven initiatives such as a peer mentoring program, peer recruitment, consumers joining author teams, and participation in other knowledge translation activities. Whether you are a consumer or a researcher, our panel will welcome audience discussion about these aspects and possible challenges facing the Collaboration in the future.

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Cochrane Canada Live: Webinars for Cochrane and beyond Adrienne Stevens, Canadian Cochrane Centre, Ottawa, Canada; Jeremy Grimshaw, Ottawa Hospital Research Institute and Canadian Cochrane Centre, Ottawa, Canada; Luis Gabriel Cuervo, Pan American Health Organization/World Health Organization, Washington, U.S. Background: Online learning is an important means to facilitate the educational needs of those producing and using systematic reviews. Online learning initiatives, such as the UK Cochrane Centre’s Online Learning Resources, have already been underway in the Collaboration to address those needs. The Canadian Cochrane Centre, through a partnership with the Pan American Health Organization/World Health Organization, has developed a webinar (web seminar) broadcast stream to help fulfill a role in education for those in the Collaboration and beyond. Objective: To describe the Cochrane Canada Live webinar broadcast stream as a new educational resource. Description: Cochrane Canada Live is the broadcast webinar stream coordinated by the Canadian Cochrane Centre using the Elluminate Live!® interface. The interface allows real-time interaction among the moderator, speaker, and participants and includes features such as live polling, application sharing, web touring, file transfer, handling multimedia files, and the ability to record and archive for later viewing. The first and ongoing research webinar series was launched in 2009 and addresses topics related to systematic reviews. The speaker will discuss the grassroots development of this series, the purposes we hope that it serves, how the interface works, and our vision for the future. Effects of an evidence service on health system policymakers’ use research evidence: A protocol for a randomized controlled trial Michael Wilson, John Lavis, Brian Haynes, Steven Hanna, Parminder Raina, McMaster University, Hamilton, Canada; Jeremy Grimshaw, Ottawa Hospital Research Institute, Ottawa, Canada; Russell Gruen, Monash University, Victoria, Australia; Mathieu Ouimet, Université Laval, Quebec City, Canada. Background: We developed an evidence service that draws inputs from Health Systems Evidence to provide health system policymakers with timely access to synthesized research

evidence. Objectives: To evaluate whether a ‘full-serve’ evidence service increases the use of synthesized research evidence by policy analysts and advisors in the Ontario Ministry of Health and LongTerm Care (MOHLTC) as compared to a ‘self-serve’ evidence service. Methods: We will conduct a two-arm randomized controlled trial (RCT), along with a follow-up qualitative process study in order to explore the findings in greater depth. All policy analysts and policy advisors (n=168) in a single division of the MOHLTC will be invited to participate. Participants will be randomized to receive either the ‘full-serve’ evidence service (database access, monthly email alerts, and full-text article availability) or the ‘self-serve’ evidence service (database access only). The trial duration will be 10 months. The primary outcome will be the mean number of site visits/month/user between baseline and the end of the intervention period. The secondary outcome will be participants’ intention to use research evidence. We will then interview 15 participants from each trial arm about and their experiences with the evidence service and how and why it was helpful (or not helpful) in their work. Results: This is a protocol and no results are currently available. Conclusions: To our knowledge, this will be the first RCT to evaluate the effects of an evidence service specifically designed to support health system policy-makers in finding and using research evidence.

Oral Session 5: Practical
Wednesday 16 February 2011; 1 - 2:30 p.m.; Emerald B & C Moderator: Alan Cassels Bringing Cochrane Evidence to Frontline Clinicians Christopher Adlparvar, Cochrane Hypertension Group, Vancouver, Canada; Aaron Tejani, Fraser Health, Burnaby, Vancouver, Canada. Background: After reviews are produced it has become a challenge for the new evidence to enter clinical practice. In many cases this is because of the academic nature of the conclusions and accessibility challenges to clinical practitioners. Educational events in which Cochrane Reviews have been synthesized to answer specific clinical questions facilitate the uptake of the evidence. Methods: Produce a variety of knowledge translation and dissemination tools and to measure their effectiveness and key features for success such as clinical evidence workshops and critical appraisal courses. The Cochrane Hypertension Group has synthesized high quality health evidence from the publication of numerous systematic reviews and wishes to translate and disseminate this evidence through the development of

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presentations, publications and evidence summaries. Results: The Cochrane Hypertension Group (CHG) in partnership with the Therapeutics Initiative, Fraser Health and Coastal Health Authorities, and the Canadian Institutes of Health Research has held three educational events over a year, which have been well attended and changed the practice of clinicians in the greater Vancouver region. Conclusions: Development of partnerships is crucial to success. Partnerships provide resources required for the reviews while assisting in the development of clinical relevant questions to be answered by Cochrane Reviews. Changes in practice are a very rewarding part of producing a review which is an incentive for members of health organizations to increase their involvement with The Cochrane Collaboration. Most clinicians have great respect for the reviews of The Cochrane Collaboration and are willing to put findings into practice, while people skeptical of Cochrane Reviews change their perspective once they have been to a critical appraisal course. Evidence Mapping to Inform the Prevention, Treatment and Harms Reduction for Illicit Drug Use: A Practical Exercise Chantelle Garritty, Mohammed Ansari, Fatemeh Yazdi, Kavita Singh, James Galipeau, Mistrel Pratt, Raymond Daniel, David Moher, Ottawa Hospital Research Institute, Ottawa, Canada; Matthew Young, Canadian Centre for Substance Abuse, Ottawa, Canada; Rebecca Skidmore, Ottawa, Canada; Jeremy Grimshaw, Canadian Cochrane Centre and Ottawa Hospital Research Institute, Ottawa, Canada. Background: In addition to the health hazards posed by illicit drugs, the social and economic costs on Canadian society are well known. With funding from the Canadian National Anti-drug Strategy, the CIHR Institute of Neurosciences, Mental Health and Addiction (INMHA) though Cochrane Canada, sought to determine what knowledge syntheses exist to inform strategic planning of future funding initiatives for illicit drug use. Given the broad evidence base to review over a six-week period, we chose evidence mapping as the most appropriate synthesis tool. Objectives: To determine what systematic review (SR) evidence exists to inform the prevention, treatment and/or harm reduction for illicit drug use using a systematic process intended to classify the volume and characteristics of the identified evidence. To discuss practical implications of findings to guide those embarking on SRs of illicit drug interventions. Methods: We searched various electronic sources for SRs examining the pre-defined interventions. We extracted and charted data by interventions, population, underlying substances, and other useful characteristics.

Results: Of 8,581 citations identified, we reviewed 761 full-text articles with 116 SRs meeting inclusion criteria. Of the SRs related to treatment (n=102), prevention (n=5) and/or harms reduction (n=16), 53 per cent reported a meta-analyses and 40 per cent were Cochrane Reviews. Further findings will be presented. Conclusions: This oral session discusses mapping as a pragmatic way to rapidly identify and categorize information; provides insight into gaps in the existing literature; demonstrates mapping as a useful complement to a full SR; and highlights methodological issues associated with knowledge syntheses research involving illicit drugs. What information are pharmaceutical sales representatives providing to family physicians? A comparative study in three countries Barbara Mintzes, University of British Columbia, Vancouver, Canada; Joel Lexchin, York University, Toronto, Canada; Ellen Reynolds, University of British Columbia, Vancouver, Canada. Background: The information provided by sales representatives has been shown to influence physicians’ prescribing decisions, an influence that is often underestimated. All medicines can cause harm as well as benefit; accurate, balanced information includes both components. Objectives: To compare the frequency with which pharmaceutical sales representatives provide information to family physicians on benefits and harm of medicines in three regulatory environments. Methods: This is the first comparison of safety-related information provided by sales representatives in different regulatory environments. We carried out a comparative crosssectional study in Vancouver, Montreal, Sacramento and Toulouse. Physicians who regularly saw sales representatives were recruited to report on consecutive sales visits. These sites represent three national regulatory environments: France has the ‘toughest’ approach internationally; the US is intermediate; and Canada reflects international norms. Results: Serious adverse events were rarely mentioned in any of the sites, and no information on harm was recorded in twothirds of promotions in Vancouver, Montreal, and Sacramento. Qualified and unqualified safety claims, and information on benefits, were noted much more frequently. There were differences in Toulouse in provision of free samples, and food (‘drug lunches’), and both common adverse events and contraindications were mentioned more often. Conclusions: Some important differences to the sales visit

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were seen. However, in all four sites, physicians received inadequate information on serious and common harmful effects of medicines and contra-indications to use, raising questions about whether information quality is compromising protection of patients’ health. Are computerized clinical decision support systems effective at improving the process of care and patient outcomes, and what makes an effective system? A decisionmaker-researcher partnership systematic review Pavel S Roshanov, Brian J Hemens, Nathan M Souza, Natasha Fernandes, Health Research Methodology Program, McMaster University, Hamilton, Canada; Robby Nieuwlaat, Population Health Research Institute, McMaster University, Hamilton, Canada; Navdeep Sahota, Medical Student, College of Medicine, University of Saskatchewan, Saskatoon, Canada; Jeffrey Wilczynski, Health Studies Program, McMaster University, Hamilton, Canada; R Brian Haynes, Department of Medicine, McMaster University, Hamilton, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; for the CCDSS Systematic Review Team and the Ad-hoc Working Group on Determinants of CCDSS Success. Background: Despite decades of research on computerized clinical decision support systems (CCDSSs), results from rigorous evaluations remain mixed and little is known about what makes an effective system. Previous systematic reviews seeking characteristics important for success were limited by small sample sizes and poor quality of primary studies. Objective: To determine if CCDSSs are effective at improving care processes or patient outcomes, and to identify characteristics associated with effectiveness. Methods: A systematic review of randomized trials comparing use of CCDSSs to usual practice or non-CCDSS controls in clinical care settings. We conducted literature searches to January 2010 in bibliographic databases and scanned reference lists. Guided by partnerships with clinicians and senior hospital administrators, we considered over 50 trial and system characteristics. Authors of all included primary studies were contacted to provide additional information and to help select features potentially associated with effectiveness. Two outcome categories were analyzed independently: ‘process of

care outcomes’ (such as appropriate monitoring of disease) and ‘patient outcomes’ (such as values of test results). Results: In the 166 included trials, success rates for process of care and patient outcomes averaged 60 per cent and 24 per cent, respectively, across six categories of application: toxic drug monitoring and dosing, acute care, primary preventive care, chronic disease management, diagnostic test ordering, and drug prescribing. We will use univariate and multivariate analyses to identify features significantly associated with effectiveness. Conclusions: CCDSSs affect the process of care but have limited benefit for patients. Our analysis will provide empirical guidance on effectiveness, optimal design and implementation.

Oral Session 6: Credible
Wednesday 16 February 2011; 3 - 4:15 p.m.; Pearl Room (Level 2) Moderator: Alain Mayhew Identifying priority content area gaps in health services and policy research Andrew Cheung, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Alain Mayhew, Cochrane Effective Practice and Organisation of Care Group (EPOC), Ottawa, Canada; Jeremy Grimshaw, Ottawa Hospital Research Institute, Ottawa, Canada; John Lavis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Michael Wilson, Program in Policy Decision-Making, Hamilton, Canada, Ontario HIV Treatment Network, Toronto, Canada. Background: Listening for Directions 3 (LfD3) was a series of consultations held in 2007 across Canada to determine the research needs of healthcare decision-makers. No efforts have been made to assess whether these needs have been addressed. Objectives: The purpose of this study was to identify priority content area gaps in health services and policy research by mapping available systematic reviews to the 11 priority themes and 98 illustrative questions identified during LfD3. Methods: We identified all systematic reviews and systematic review protocols available as of June 2010 in Health Systems Evidence and Rx for Change, two large and regularly updated repositories of health services and policy research. We mapped these reviews and protocols to relevant LfD3 priority themes and illustrative questions within the priority themes. Results: We found a large amount of variation in the number of relevant systematic reviews and protocols across priority themes. ‘Workforce and the work environment’ had the greatest number of relevant publications (n=702), while ‘Data, information and knowledge management’ had the fewest (n=9). We found that 61 of the 98 illustrative questions in the LfD3 final report

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were not addressed by any of the reviews or protocols. Conclusions: While certain priority themes had many relevant systematic reviews and/or protocols, most of the illustrative questions from LfD3 were not addressed by research available in these two large databases of health systems evidence. Authors of future reviews should consider the findings of LfD3 and this project to ensure their work addresses the needs of decision-makers. Searching or finding? Recommendations for equity relevant searches Jordi Pardo Pardo, Vivian Welch, Tamara Rader, Jessie McGowan, University of Ottawa, Ottawa, Canada. Background: Assessing health inequities is an important consideration for public policy decisions. While there is some guidance on how to assess equity for users and authors of systematic reviews of interventions, there is a lack of guidance on how to proceed with the searches for primary studies. Objective: To test different approaches to identify equity relevant studies and provide recommendations to guide searching activities for equity-focused systematic reviews. Methods: Literature search of methods papers assessing the information retrieval process to consider health equity assessment, as well as analysis of exemplar systematic reviews and their approaches to searching. Results: Use of equity filters has important limitations particularly the failure to retrieve potentially relevant studies. Combination of different approaches to information retrieval, from the selection of the relevant databases to reference snowballing, expert contact and use of reference indexes provided additional relevant studies for the exemplar systematic reviews. Conclusions: Equity relevant papers are hard to identify, and health relevant studies are published in journals of other disciplines. A wide variety of strategies should be considered to ensure all relevant interventions are adequately covered. Greater focus on health equity in systematic reviews may improve their relevance for both clinical practice and public policy making. A survey of the completeness of safety reporting in Complementary and Alternative Medicine (CAM) trials Lucy Turner, Kavita Singh, James Galipeau, Mistral Pratt, Sophia Tsouros, Alexander Tsertsvadze, Chantelle Garritty, David Moher, Ottawa Hospital Research Institute, Ottawa, Canada; Eric Manheimer, Susan Wieland, University of Maryland, Baltimore, U.S. Background: Adequate reporting of safety in primary publications of randomized controlled trials (RCTs) is a prerequisite for accurate and comprehensive evaluation of conventional as

well as CAM treatments. In 2001, Ioannidis and Lau published a study in which they assessed the completeness of safety reporting in RCTs of conventional therapies, across seven major areas of conventional medical. The study authors found that safety reporting in the conventional treatment literature was largely inadequate. The adequacy of safety reporting has not been assessed for RCTs of CAM interventions. Objective: We aimed to survey and assess the completeness of safety reporting for RCTs of CAM treatments. Methods: In collaboration with the Cochrane CAM field, a group of systematic reviewers have adapted certain aspects of the methodology reported by Ioannidis and Lau to investigate the adequacy of safety reporting in CAM RCTs. Our search was conducted within the Cochrane CAM specialized register of 2009 trials. Results: We will present results of our review, which includes 208 trials of 15 high impact CAM interventions. We will discuss how these results may guide future reporting of adverse events in CAM trials and provide recommendations for improved safety reporting practices. Conclusion: It has been previously shown that the quality of reporting of safety data for trials needs to be improved, the CONSORT extensions provide much guidance in this area, but more should be done to widely disseminate and continually develop such valuable resources. We would like to thank our funders the National Council for Complementary and Alternative Medicine (NCCAM) for enabling the completion of this project.

Oral Session 7: Practical
Wednesday 16 February 2011; 3 - 4:15 p.m.; Emerald B & C Moderator: Mary Ellen Schaafsma Drug Use Optimization (DUO) at the British Columbia (BC) Ministry of Health Services, Pharmaceutical Services Division: Decreasing demand by increasing evidencebased knowledge translation Suzanne Taylor, Sarah Jennings, Terryn Naumann, Barbara Gobis-Ogle, Anne Nguyen, Kelly Grindrod, Aileen Mira, Elisheba Muturi, Weiwei Du, Dorothy Li, Jesmina Biserovic, Derek Tryan, Erin Guiltenane, Rhea Sclentzas, Natalie Veltri, Bob Nakagawa, Pharmaceutical Services Division, BC Ministry of Health Services, New Westminster, Canada. Background: The Pharmaceutical Services Division embodies a therapeutically oriented pharmaceutical management system

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that includes consideration of best drugs, best policies, best deals, and best prescribing. Four branches bring this system to life. The DUO branch focuses on best prescribing, supporting pharmacists to work to their full scope of practice, and facilitating evaluation of real world safety and effectiveness and real world cost-effectiveness. Objectives: The DUO branch mission is to educate and engage the province’s prescribers, other health professionals, patients, and public on the optimal use of medications to achieve improved health outcomes in a fiscally responsible manner and to evaluate the impact of programs and services. Methods: DUO is involved with facilitating and evaluating multifaceted evidence-based, best-practice, optimal use behavioural change initiatives such as Provincial Academic Detailing, Education for Quality Improvement of Patient Care, Do Bugs Need Drugs, BC Medication Management Project, Clinical Pharmacy Services under the BC Pharmacy Services Agreement, Health Literacy initiatives, implementation of Canadian Agency for Drugs and Technologies in Health optimal use recommendations, linkages for development of BC Guidelines, contributions to professional newsletters and conferences, and educational outreach visits to health fairs and community groups. Results: This presentation will provide examples of some of the accessible, credible, and practical initiatives that DUO supports to help facilitate a sustainable health care system that optimizes health outcomes and optimizes use of medications and medication-related human resources. Conclusion: Collaborative aligned messaging and relationships are keys to successful behavioural change strategies. Evaluation is key to validating this important work. A Systematic Review of Pharmaceutical Policies that Restrict Reimbursement Carolyn Green, Stan Bardal, University of Victoria, Victoria, Canada; Malcolm Maclure, Patricia Fortin, University of British Columbia, Vancouver, Canada; Craig Ramsay, University of Aberdeen, Aberdeen, UK; Morten Aaserud, Norwegian Medicines Agency, Oslo, Norway. Background: Public policy-makers and benefit plan managers need to restrain rising pharmaceutical drug costs while preserving access and optimizing health benefits.

Objectives: To determine the effects of a pharmaceutical policy restricting the reimbursement of selected medications on drug use, health care utilization, health outcomes and costs (expenditures). Methods: Fourteen major bibliographic databases and websites were searched to January 2009 for studies of restriction to reimbursement policies. Randomized controlled trials, nonrandomized controlled trials, interrupted time series (ITS) analyses, repeated measures studies and controlled beforeafter studies set were included. Two reviewers independently extracted data and assessed study quality. Results: We included 29 ITS analyses (12 were controlled) investigating policies targeting 11 drug classes for restriction. Impact of policies varied by drug class and whether restrictions were implemented or relaxed. When policies targeted gastricacid suppressant and non-steroidal anti-inflammatory drug classes, decreased drug use and substantial savings on drugs occurred immediately and for up to two years afterwards, with no increase in the use of other health services (six studies). Targeting second generation antipsychotic drugs increased treatment discontinuity and the use of other health services without reducing overall drug expenditures (two studies). Relaxing restrictions for reimbursement of antihypertensives and statins increased appropriate use and decreased overall drug expenditures. Two studies which measured health outcomes directly were inconclusive. Conclusions: Restriction to reimbursement policies can meet intended policy objectives however, policy design needs to be based on accurate harm benefit profile quantification of target and alternative drugs to avoid unwanted health system and health effects. Using Evidence-Based Research to Inform Practice in a Medical Specialty Society Becky Skidmore, Vyta Senikas, The Society of Obstetricians and Gynaecologists of Canada (SOGC), Ottawa, Canada; Jim Ruiter, SALUS Global Corporation, London, Canada. Background: Many medical specialty societies provide Continuing Medical Education (CME) programs to members. Content should be rigorously developed and consistent across programs. Objectives: To develop and sustain a credible and consistent core evidence base in obstetrics to inform SOGC’s main educational programs (ALARM, ALARM International, MOREOB), and to maintain a database of best-evidence references and full text. Methods: The Obstetrical Content Review committee was formed in 2006. It includes multi-disciplinary healthcare professionals (obstetricians, MFN specialists, GPs/FPs, RNs,

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midwives), representatives from each educational program and key committees, and an information specialist (IS). Each member commits to three years+; rotation is staggered. We systematically search The Cochrane Library, PubMed and CINAHL. Members receive training and appreciation of Cochrane Reviews and methods. Members scan and select potentially relevant references for full-text acquisition and appraisal. A critical path outlines member workload, expectations and deliverables. Search updates, screening and appraisals occur quarterly. The committee meets annually to collectively review new evidence that impacts practice before updating core content for programs. Results: We met six times and screened 25,320 references. We selected and critically appraised 2,280 full-text, resulting in 726 up-to-date references in the latest revision. Core databases, critical appraisals and manuscripts are maintained and easily accessible in-house. We also improved processes and information sharing with SOGC guideline committees. Conclusions: Through increased rigour and transparency, this model enhances consistency in evidence-based obstetric practice. CME content is standardized and validated. Information and skill-sharing creates efficiencies and consistencies for SOGC programs and products. A similar model is under consideration for gynaecology.

Evaluation: An online survey will be given one month after the promotional activity. In depth interviews with the Cochrane consumers who perform promotional activities will take place after the event. Outcomes: Based on the results, and experiences of the participants, we plan to develop a Promotion Kit that any Cochrane consumer could use to guide the dissemination of reviews or to promote The Cochrane Collaboration. This process would at minimum include: How to identify and prioritize stakeholders/end users, strategies to make initial contact with end users, communication ideas e.g. newsletters, websites. The Promotion Kit would also include existing material used by other Cochrane entities. A Systematic Review on Research Implementation in Allied Health Professions Lauren Albrecht, Shannon Scott, Geoff Ball, Donna Dryden, Canada; Lisa Hartling, Allyson Jones, Amanda Newton, Terry Klassen, University of Alberta, Edmonton, Canada; Anne Hofmeyer, University of South Australia, Adelaide, Australia; Kathy Kovacs Burns, Alberta Health Services, Edmonton, Canada; David Thompson, Northern Ontario School of Medicine, Thunder Bay, Canada. Background: Knowledge translation (KT) aims to close the gap between knowledge and practice in order to realize the benefits of research through (a) improved health outcomes, (b) more effective health services and products, and (c) strengthened health care systems. While there is some understanding of strategies to put research findings into practice within nursing and medicine, we have limited knowledge of KT strategies in allied health professions. Given the inter-professional nature of health care, a lack of guidance for supporting KT strategies in the allied health professions is concerning. Objective: To systematically review published research on KT strategies in five allied health disciplines. Methods: A medical research librarian searched eight databases. Two reviewers performed study selection and quality assessment. Data were extracted by one reviewer and verified by a second. Within each profession, data were grouped by research design and KT strategies using the Effective Practice and Organisation of Care Review Group classification scheme. An overall synthesis across professions was conducted. Results: Of the 2,630 studies identified, 31 studies were included and represented the following professions: pharmacy (n=12), physiotherapy (n=10), occupational therapy (n=6), dietetics (n=3), and speech-language pathology (n=2). The predominant KT intervention across disciplines was educational meetings

Oral Session 8: Accessible
Thursday 17 February 2011; 10:30 - 11:45 a.m.; Pearl Room (Level 2) Moderator: John MacDonald Knowledge Translation by Consumers: A case series on the promotion of The Cochrane Collaboration Janet Gunderson, Tamara Rader, Marilyn Walsh, Chris Fyfe, Anne Lyddiatt, Lara Maxwell, Elizabeth Ghogomu, Cochrane Musculoskeletal Group, Ottawa, Canada. Background: At the 2009 Canadian Cochrane Symposium, consumers identified ‘Promotion’ as one of four priority activities for 2009-2010. It was felt that Canadian members of CCNet (Cochrane Consumer Network) could promote The Cochrane Library and the work of The Cochrane Collaboration to their local consumer health groups, charities, churches, schools and other social networks. Methods: Telephone and email support by the Cochrane Musculoskeletal Group and materials from Cochrane Canada will be provided and promotion packages will be developed to help consumers become equipped to plan a promotion activity in their local area. We will document the experiences of the consumers and present a series of case reports.

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(n=17), followed by multiple interventions (n=9), educational material (n=2), educational outreach visits (n=2) and financial provider (fee-for-service) intervention (n=1). Analysis on the effect of these interventions is ongoing. Conclusion: A uni-professional approach to KT does not represent the inter-professional context it targets. Our findings provide the first systematic overview of KT strategies used in allied health professionals’ clinical practice, as well as a foundation to inform future KT interventions in allied health care settings. A systematic review examining organizational characteristics that influence knowledge translation in healthcare Anastasia A. Mallidou, Carole Estabrooks, Ferenc Toth, Greta Cummings, University of Alberta, Edmonton, Canada; Alison Hutchinson, Cabrini Health, Australia; Corinne Schalm, Shepherd’s Care Foundation; Edmonton, Canada. Background: There is adequate evidence that organizational characteristics influence knowledge translation in the healthcare settings. We build upon and expand previous work on the influence of contextual characteristics on knowledge translation. Objectives: To systematically review qualitative and quantitative publications on the impact of organizational context on knowledge translation in healthcare settings. Methods: In 2009, we conducted a comprehensive search of 13 electronic databases, without restriction on publication date, research design or language. Search terms included organization, characteristics and knowledge translation/ research utilization combined according to conventions of each database. We identified 28,415 non-duplicated titles. Two researchers independently screened the titles and abstracts using predetermined inclusion/exclusion criteria. Next, we retrieved full-text articles for screening. Using a structured data extraction form, we extracted key information from each publication and two reviewers independently assessed quality of included publications. Discrepancies at each stage were resolved by consensus. Relevant theoretical literature was retained for future analysis. Results: In total, 88 research publications remained for review and synthesis. These included 49 quantitative (mainly crosssectional survey design), 38 qualitative (mainly explored perceptions of barriers/facilitators to research use) and one

mixed-method publications. Conclusions: The findings suggest that modifiable organizational characteristics influence knowledge translation in healthcare settings. These characteristics have direct applicability to healthcare policy-makers, decision-makers and practitioners. The findings can inform efforts to implement interventions and promote research use, which ultimately result in improved patient and provider outcomes. A ‘Rapid Response’ service for community-based organizations in the HIV/AIDS sector Michael Wilson, Sean Rourke, Jean Bacon, Sergio Rueda, Ontario HIV Treatment Network, Toronto, Canada. Background: Community-based organizations need support in finding and using research evidence to help them plan and deliver effective and cost-effective programs. Objectives: To develop and evaluate a ‘rapid response’ service that provides support to community-based organizations in the HIV/AIDS sector that need timely access to research evidence to inform their decision-making, service delivery and/or advocacy. Methods: We developed guidelines for producing rapid research syntheses for timelines varying from one - two days to more than one month. For each request we search key sources for relevant systematic reviews (The Cochrane Library, Database of Abstracts of Reviews of Effects, Health-Evidence. ca) and conduct targeted searches for primary literature. We then develop a one - two page summary that provides the question, an outline of the issue, key take-home messages, an outline of the more detailed findings and factors that may affect local applicability. In addition, we are currently conducting a qualitative evaluation with those who have requested a rapid response to assess how useful it was and how the synthesis was used to inform their work. Results: We have completed 35 rapid response requests since March 2009, which address a wide spectrum of topics related to prevention, treatment, care and support for people living with or at-risk for HIV/AIDS. The qualitative evaluation is currently inprogress and will be completed by February 2011. Conclusions: Our rapid response service provides timely access to research evidence for community-based organizations that may not otherwise have the time or capacity to find and use it in their decision-making, service delivery and/or advocacy.

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Oral Session 9: Practical
Thursday 17 February 2011; 10:30 - 11:45 a.m.; Emerald B & C Moderator: Jordi Pardo Pardo Database Search Order Can Be Made More Efficient Charlie Goldsmith, Simon Fraser University and Arthritis Research Centre of Canada, Vancouver, Canada; Gary Foster, McMaster University, Hamilton, Canada. Background: Cochrane Reviews show less than optimal search orders, and are seldom numerical. Objectives: Can database search order be made more efficient for the next search? Methods: Database searches can be expressed as a contingency table that arises with the frequencies from the products of the k databases as a 2**k table with one missing cell. This missing cell can be estimated with Poisson regression and hence a Horizon can be constructed as the total possible articles. Using this horizon estimate as the denominator, the numerator can be the number of known articles after each database search has been completed, so these cumulative yields can be converted to percentages of the horizon as a success criterion for the search order. Results: Examples with five database searches from: 1) breast margin articles, 2) hand-washing articles and four databases searches of 3) neck pain therapy, 4) nephrology journals, 5) osteoporosis management articles and 6) neck disability index reliability articles all showed more optimal search orders that could be used meta-analysis updates. For the breast margin search, 97 per cent of the articles could be obtained from PubMed, Embase and The Cochrane Library, while no additional articles came from Cinahl or CancerLit. For the Neck Disability Index reliability, 97 per cent of the articles were found with Embase and Cinahl with no additional articles from Medline and PsycInfo. Results will be shown for the other four searches. Conclusions: More optimal searches are possible with Cochrane search strategies and can be made numerical with horizon estimation. How can we discover clinicians’ real-world medical knowledge retrieval patterns? Pavel S Roshanov, Health Research Methodology Program, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; Jeanette Prorok, Emma Iserman, R Brian Haynes, Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. Background: When looking for validated medical knowledge to support their clinical decisions, clinicians are encouraged to

begin their search at the highest possible levels of the evidencebased information hierarchy (summaries). If their question is not convincingly addressed, they should continue through lower level resources (synopses, syntheses, and single studies). However, little is known about how clinicians search for validated medical information in real practice. Objective: To develop and test a method for discovering and quantifying real-world medical information retrieval processes. Methods: We collected web-usage data (including records of each action, who executed it and when) from 253 users conducting 754 retrieval sessions using the McMaster PLUS Federated Search engine. We analyzed the data with process mining algorithms available in the ProM Framework to quantify and present graphically the real-world information retrieval patterns of clinician and student users. Results: For example, we found that 80 per cent of searches begin at summary resources (e.g. Up-to-Date), and while 76 per cent of those searches end there, another 10 per cent continue in synopses of syntheses (e.g. DARE) and 10 per cent move directly to the lowest level (individual studies). Users never begin with individual studies and rarely use syntheses or synopses of studies. Conclusions: Discovering and quantifying real-world information retrieval processes is important as we develop and evaluate medical information resources. In this small pilot test, we were able to discover the routes that users take to find answers to their clinical questions, the specific resources they visit, and the time consumed by each route. A larger study is ongoing. The perfect threesome: students, clinician researchers, and Cochrane Aaron M Tejani, Cochrane Hypertension Review Group, Vancouver, Canada; Josh Batterink, Sarah Stabler, Sarah West, University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, Canada; Fong Hyunh, St. Paul’s Hospital, Vancouver, Canada. Background: The rate of publication of Cochrane Reviews is growing yearly however many clinical questions have still to be answered, many titles/protocols have been abandoned, and there are many reviews that are in urgent need of updating. Additionally, there is literature suggesting that clinicians-intraining are not given sufficient education on critical appraisal of evidence nor are they taught to value the information from systematic reviews. Another undeniable concern is the lack of capacity and resources available to clinician researchers who want to produce and publish reviews in The Cochrane Library.

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Objective: In order to overcome these obstacles, a group of clinicians-in-training along with clinician researchers have formed a team that focuses on publishing systematic reviews in The Cochrane library. Results: As a result of team collaboration, five new reviews were initiated, two abandoned protocols were renewed, and six submissions of feedback were written resulting in 11 publications in The Cochrane Library (primarily through the Cochrane Hypertension Review Group). Conclusions: The formation of this team has allowed new members to receive extensive training in critical appraisal and systematic review methodology and has created a sustainable resource infrastructure for continued publication of systematic reviews in The Cochrane library. More importantly, clinicians-intraining are provided the opportunity to participate in first-hand exposure in several key aspects of The Cochrane Collaboration We will describe the successes and challenges our team has encountered as well as providing tips for emerging teams wishing to adopt a similar process. Surgical smokes in the operating theatre: Using best evidence for health risk assessment Marc Rhainds, Mélanie Hamel, Martin Coulombe, UETMIS du CHUQ, Québec, Canada. Background: It is suggested that surgical smokes produced during surgical procedures may be harmful for healthcare professionals. Objectives: To assess health risks from occupational exposure to surgical smokes. Methods: Systematic reviews, randomized controlled trials (RCTs) and experimental studies on surgical smokes were retrieved in Pubmed, and The Cochrane Library (until June 2010). Grey literature was also searched. Article selection, quality assessment, data extraction and synthesis were performed by one reviewer. Appraisal was carried out by three reviewers. Synthesis review was shared with an expert group. Results: One systematic review but no RCTs were found. Results from observational and experimental studies show that surgical smoke produced by electrocautery, ultrason scalpel and laser, for a wide range of surgeries, may contain biological (bacteria, virus, and metastatic cells) and chemical contaminants. The viability of cells in the surgical smokes and the

potential of communicable diseases to healthcare professionals remain unclear. Data from surgical smokes analyses, measured from the breathing area and in the operating room, suggest that ambient air concentrations of carbon monoxide, volatile organic compounds (benzene, toluene, ethylene, xylene), and inhalable particles are very low and far below the occupational standards. However, various symptoms (e.g. headache, soreness of eyes and throat) are reported with exposure to surgical smokes. Conclusions: Although there is no clear evidence that surgical smoke may represent health hazard in the operating theatre, many occupational safety and standards organizations recommend in addition to individual protection measures, to improve smokes evacuation in the operating theatre including use of portable evacuation systems.

Oral Session 10: Accessible
Thursday 17 February 2011; 12:30 - 12 p.m.; Topaz Room (Level 2) Moderator: Victoria Pennick Health-evidence.ca: A Canadian resource facilitating access and use of review-level evidence Paula Robeson, Heather Husson, Kara DeCorby, Maureen Dobbins, Lori Greco, Health Evidence, McMaster University, Hamilton, Canada. Background: Health-evidence.ca is an online registry of preappraised, review-level evidence evaluating the effectiveness of interventions to support evidence-informed decision making (EIDM) in public health. Objectives: To facilitate access to and use of review-level evidence for Canada’s public health decision makers. Methods: Content is updated quarterly through comprehensive searches (seven electronic databases, 50 handsearched journals, reference lists of relevant reviews). All reviews are indexed, assessed for relevance and methodological quality by two independent reviewers. Two-page evidence summaries identify key findings and link evidence to actionable implications; registered users tailor information to areas of interest; built-in feedback links enable users to suggest site improvements; two knowledge brokers are available to support users in interpreting and applying evidence; social media provide a forum for improving awareness and registry use. Tools to support EIDM are available. Results: The Registry houses over 2,000 reviews, with summaries for 80 methodologically strong ones. Electronic tailored messages are sent quarterly to 5,000 registered users. The registry sees 40,000 visitors annually (~105/day); daily visits increase 500 per cent following tailored messages. Social media engagement has produced three YouTube videos sharing users’

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experiences with the registry, and a growing Twitter following (156 followers) focused on EIDM. Real-time registry updates are posted to Twitter between quarterly updates. Seven modifiable EIDM tools are downloadable. Conclusions: Health-evidence.ca is a go-to source of published research evidence in public health and health promotion effectiveness. EIDM services building upon the registry are tailored to the needs of users and focus on making access and use of evidence easier. Making Decisions using Cochrane evidence: A practical tool for patients and their health care providers Tamara Rader, Lara Maxwell, Elizabeth Ghogumu, Vivian Welch, Peter Tugwell, Cochrane Musculoskeletal Group, Ottawa, Canada. Background: Although methodologically rigourous and extremely detailed, Cochrane Reviews can be unwieldy when people try to use them in practice. The Musculoskeletal Group has developed a series of patient decision aids to make using Cochrane evidence easier when making decisions by providing evidence-based information about a treatment option including benefits, harms, probabilities, and scientific uncertainties and by clarifying personal values. They are designed to complement, rather than replace, counselling from a health practitioner. Objectives: To produce patient decision aids based on evidence from Cochrane Reviews and to discuss issues and barriers encountered in their development. Methods: Each decision aid topic was chosen in consultation with the Coordinating Editor and Managing Editor based on popularity of the intervention, clinically important results, and suitability for use in patient decision making. Decision aids were developed in accordance with International Patient Decision Aid Standards (IPDAS). Evidence was taken from the Summary of Findings table of the review for patient-important outcomes such as pain and physical function. The decision aids were checked for clinical accuracy by a rheumatologist and for clarity and usefulness by the Cochrane Musculoskeletal Consumer Group. Further iterations where developed and approved by the CMSG editors. Results: Ten decision aids are available to the public for download from the CMSG website. A manuscript about the knowledge translation activities (highlighting the decision aids) of the Musculoskeletal Group is in progress. Conclusions: Decision aids can make the evidence from Cochrane reviews useful and practical and support shared decision-making for patients and clinicians.

Consumer Impact On Arthritis Research Janet Gunderson, Dawn Richards, Jean Légaré, Linda Wilhelm, Louise Bergeron, John Coderre, Delia Cooper, Christopher Debow, Simone Hughes, Anne Riddick. Background: The Consumer Advisory Council has been working with the researchers of CAN since 2000 Objective: To demonstrate the relevance and value of consumer involvement in arthritis research with examples specific to the Canadian Arthritis Network (CAN). Methods: The consumers on CAN’s Consumer Advisory Council (CAC) works with researchers, students, and stakeholders to shape research and training initiatives. CAC impacts research through: membership on committees and integration into CAN’s governance structure, collaborating and advising on research projects, participating in training activities, and engaging in KTE. Results:

Consumers are voting members on each CAN committee and act as peer reviewers on the Scientific and Medical Advisory Committee and the Training and Education Committee. Consumers collaborate with researchers by giving advice and support on research projects as well as participating in KTE regarding that research. Consumers act as co-presenters in each session at the CAN Annual Scientific Conference, as well as presenting at training activities for peers as well as CAN Trainees. Consumers are involved in KTE activities within CAN and externally to CAN. Consumers are regularly involved with writing articles and papers.

Conclusion: Consumer participation in CAN’s research-related activities provides people living with arthritis the opportunity to work with researchers on CAN’s mission of a world free of arthritis. This presentation showcases the relevance and value of consumer involvement in arthritis research by using examples specific to CAN. Consumer Support in Difficult Times through Patient-toPatient Information about The Cochrane Collaboration: A Case Study Marilyn Walsh, Tamara Rader, Cochrane Musculoskeletal Review Group, Ottawa, Canada. Background: While attending a national Canadian Spondylitis Association forum in April, I became aware of how uninformed some patients are about spondylitis and reliable treatments for

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it. This presentation will show how my exposure to Cochrane since 2007 has supported me in helping other patients through Cochrane’s work. Objectives: To reach as many members of the Ontario/ Canadian Spondylitis Association (CSA) as possible with the following information: 1. What is The Cochrane Collaboration? 2. What is a systematic review? 3. What is The Cochrane Library? 4. How to access the Library 5. Stress FREE access of abstracts and Plain Language Summaries 6. How patients benefit from evidence-based medicine Method: 1) Committed to writing an article for the CSA newsletter. Support and information was sought from the Musculoskeletal Group regarding content and sources of information for the article. Information was collected from the following websites: www.ccnc.cochrane.org, www.cochrane.org/consumers, as well as promotional material distributed at the last two symposiums. A draft was submitted to the Musculoskeletal Group for approval before submission to CSA newsletter editor. 2) Volunteered as a local contact for the Ontario Spondylitis Association where I am lobbying to bring a local forum to Hamilton where I have volunteered to speak about the importance of Cochrane and hope to distribute promotional materials. Results: The completed article has been accepted for publication in the next CSA newsletter and will appear in both email and mailed form. Conclusions: Consumers can help fellow patients obtain evidence-based medical information by sharing their knowledge of Cochrane with patient groups.

Oral Session 11: Credible
Thursday 17 February 2011; 12:30 - 12 p.m.; Emerald B & C Moderator: Joseph Beyene A comparison of the reporting of adverse outcomes in Cochrane versus non-Cochrane reviews Alexandra Laugerotte, Gavin Wong, James M Wright, University of British Columbia, Vancouver, Canada. Background: Systematic reviews are expected to report important benefit and harm outcomes. Despite this, it is common for benefits to be emphasized and harms sometimes overlooked. Objectives: To test this we decided to look for the incidence and quality of reporting adverse outcomes in Cochrane Reviews as compared to non-Cochrane Reviews. Methods: To obtain a sample of Cochrane and non-Cochrane Reviews we looked for all reviews studying beta-blockers as an intervention. We accepted reviews with a placebo or active treatment control. In each review we assessed whether any adverse outcomes and we assessed the quality of the reporting based on whether the following outcomes were included in the protocol from worst to best: nothing; some adverse effects; withdrawal due to adverse effects alone; all cause mortality alone; all cause mortality plus some adverse effect; all cause mortality plus withdrawal due to adverse effects. Based on this hierarchy we established a scoring system that was adjusted depending on whether the review was studying short or longterm effects. Each review was scored by two of us (AL and GW) independently and the average of the two scores was used. Results: We found 56 Cochrane Reviews and 50 non-Cochrane Reviews studying beta-blockers as an intervention. Of the 56 Cochrane Reviews 53 (94.6 per cent) reported at least one adverse outcome. The average score for reporting adverse outcomes was 3.05 out of 5. Of the 50 non-Cochrane Reviews 45 (90 per cent) reported at least one adverse outcome. The average score for reporting adverse outcomes was 2.84 out of 5. Conclusions: Reporting of at least some adverse outcomes was high in systematic reviews studying beta-blockers. Cochrane reviews tended to be higher in the proportion reporting and in the average score however, the differences were not statistically significant. Overcoming methodological challenges associated with network meta-analyses: The experience of the Musculoskeletal Group Elizabeth Ghogomu, Lara Maxwell, Jasvinder Singh, Robin Christensen, George Wells, Rachelle Buchbinder, Peter Tugwell. Cochrane Musculoskeletal Group, Ottawa, Canada. Background: Many traditional meta-analyses summarize the

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results of studies that compare an intervention to placebo. A network meta-analysis enables the comparison between different interventions in the absence of direct head-to-head comparisons. Evidence from a network meta-analysis is reliable if studies with very similar study characteristics and eligibility criteria are combined. Objectives: To discuss the methodological and process challenges involved in network meta-analyses and how to overcome them. Methods: We used the example of two Cochrane overviews of reviews on biologics involving network meta-analyses to illustrate the methodological challenges encountered and how we overcame them. We compared the efficacy and safety of six different biologics in patients with rheumatoid arthritis in the first overview. We found limited evidence on the adverse effects such as tuberculosis, life threatening fungal infections and lymphomas that may be common with biologics, so we undertook a second overview to assess the adverse effects of nine biologics across different indications of use. The unit of analysis was different in the two overviews – Cochrane systematic reviews in the first and clinical trials in the second. Results: Different methodological considerations were faced depending on the type of overview most appropriate to answer our question. Challenges included managing a large volume of data for screening and extraction; achieving consensus with a large team of extractors; preparing data for analysis; and presenting results using the RevMan overview template. Conclusion: Where limited evidence is available for direct comparisons of different interventions, well-conducted indirect comparisons based on network meta-analyses are challenging to undertake, but necessary to guide health decision making. The Influence of CONSORT on the quality of RCTs: An updated review Lucy Turner, David Moher, Larissa Shamseer, Laura Weeks, Jodi Peters, Ottawa Hospital Research Institute, Ottawa, Canada; Amy Plint, CHEO, Ottawa, Canada; Doug, Altman, Oxford University, Oxford, UK. Background: The Consolidated Standards of Reporting Trials (CONSORT) Statement was developed in response to concerns about the quality of reporting of randomized controlled trials (RCTs). It is an evidence-based minimum set of recommendations for reporting RCTs, intended to facilitate the complete and transparent reporting of RCTs and aid in their critical appraisal and interpretation. In 2006, Plint and colleagues published a systematic review examining the effectiveness of CONSORT for improving the reporting of RCTs in journals that have formally endorsed it (i.e. at minimum, recommend that authors use CONSORT). Despite poor methodology of some

included studies, use of CONSORT was found to be associated with improvement in the quality of reporting of RCTs. Over five years have passed since Plint’s review and an update is needed. Objective: This systematic review will update Plint et al.’s systematic review. Details of which will be discussed during this presentation. Methods: Conventional systematic review methods employed in the original review by Plint et al. have been employed. The search for new studies spanned August 2005 – March 2010. Two independent reviewers screened studies for eligibility; extraction and validity assessment of studies were conducted by a single reviewer and a second reviewer performed verification. Results: In the five year period since publication of the original review by Plint et al., 42 new studies were identified which met eligibility criteria for this review. We will present preliminary findings during this session. Impact: This review will provide further evidence on whether CONSORT is effective at improving the reporting of RCTs. This information will be helpful to authors, peer-reviewers and journal editors in helping to decide whether to use CONSORT.

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POSTER Abstracts
Please note: The names of poster presenters appear in bold. Theme 1: Accessible Working with Consumers to Translate the Results of a Cochrane Review into Practice Mary Brachaniec, Canadian Institutes of Health Research, Knowledge Exchange Task Force, Moncton, Canada; Angela Busch, Candice Schachter, Julia Bidonde, Vanina Dal BelloHaas, Sandra Webber, Joelle Harris, University of Saskatchewan, Saskatoon, Canada; Tom Overend, University of Western Ontario, London, Canada; Rachel Richards, North Vancouver, Canada; Adrienne Danyliw, Health Quality Council, Saskatoon, Canada; Anuradha Sawant, London Health Sciences Center, London, Canada. Background: Cochrane Review teams use explicit and reproducible methods to prepare systematic reviews on the effectiveness of health interventions. Engaging consumers in planning and preparing Cochrane Reviews helps ensure they are relevant to patients and the public; and the results are shared in an understandable and accessible way. Objectives: To describe our experience working with consumers to prepare and disseminate the results of a Cochrane Review examining the effects of exercise combined with non-exercise interventions for treating fibromyalgia syndrome (FMS). Methods: Since working with a CIHR Knowledge Exchange Task Force sub-group to disseminate the results of our Cochrane Review on exercise and fibromyalgia, we have actively engaged consumers in preparing our next review on this topic. For example, consumers helped us select study outcomes of importance to them, and contribute to regular team planning meetings. One consumer collaborator, who is on the CIHR Knowledge Exchange Task Force, is helping us craft a plan to share our results with key audiences, including clinicians and patients, in an effective manner to facilitate the translation of findings into practice. Results: Engaging consumer collaborators throughout the review process should help ensure results inform optimal exercise prescription and programs for persons with FMS. Conclusions: The iterative and organic approach that we have adopted to engage consumers in the Cochrane Review process helps ensure our review is relevant to key stakeholders, including patients; and our results are shared with them in an effective and timely manner. Social Media in Clinical Medicine: Preliminary Results from a Literature Review Francisco J. Grajales III, Sam Sheps, Western Regional Training Centre for Health Services Research, Vancouver, Canada; Dean Giustini, School of Library, Archival, and Information Science, University of British Columbia, Vancouver, Canada; Kendall Ho, Helen Novak-Lauscher, eHealth Strategy Office, Faculty of Medicine, University of British Columbia, Vancouver, Canada. Background: Social media are web-based tools and services that facilitate social interaction ‘on-the-go’ using mobile phones and handheld computers. These media include wikis (e.g. Wikipedia), social networking sites (e.g. Facebook), microblogging (e.g. Twitter), professional networking (e.g. Sermo), photo sharing (e.g. Flickr), blogs (e.g. ScienceRoll), and Multi-User Virtual Environments (e.g. Second Life), to name a few. In medicine, physicians have experimented with the use of these services in order to manage information in their work. Today, there is confusion and hype around using social media in medicine and varying opinion as to its usefulness, and no study has yet comprehensively evaluated that usefulness as claimed in the literature. Objective: To identify the evidence within the medical literature for the utility of social media in clinical medicine. Method: A narrative review of peer reviewed and grey literature is being conducted following The Cochrane Collaboration’s Handbook for Systematic Reviews of Interventions. PubMed, Google Scholar, EMBASE, CINAHL, Scopus, Web of Science and Compendex were searched as were a number of highimpact blogs, listserv archives and websites (e.g., WHO/PAHO’s Equidad and Webicina) for grey literature. Results: This is the first review article examining the social media ‘evidence base’ in the medical literature. Findings will be presented according to study methodology, population and technology used. Conclusions: The evidence-base on social media adoption and utilization in medicine is growing. However, there are a very limited number of robust studies and further research will be is required to measure the clinical impact of adopting social media in clinical medicine.

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Health Informatics from Start to Finish, or, Strike While the Iron is Hot: Informatics courses embedded in the undergraduate medical curriculum at the University of Toronto Carla Hagstrom Bissada, Elena Springall, Rita Vine, Gerstein Science Information Centre, University of Toronto Libraries, Toronto, Canada. Background: Since 2003 one of the goals of the undergraduate medical curriculum at the University of Toronto Faculty of Medicine has been to achieve CanMeds competencies. Objectives: To help students achieve CanMeds competencies as they pertain to health informatics through the four years of undergraduate medical eduation. Methods: Gerstein librarians work with faculty to create modules embedded in the curriculum that will enable students to become knowledgeable about finding, evaluating, and managing information. Modules consist of class instruction and/or videos. Content varies from introduction to health informatics to setting up current awareness delivery. Results: Students are able to use databases such as PubMed, Ovid Medline, The Cochrane Library; other online resources, e.g. Harrison’s; point of care products; RSS feeds, etc. Conclusions: Offering informatics courses over a fouryear period ensures that students not only learn how to find information, but which resources are appropriate for their needs. Health Evidence: Connecting decision makers for public health action Heather Husson, Kara DeCorby, Maureen Dobbins, Paula Robeson, Lori Greco, Health Evidence, McMaster University, Hamilton, Canada; Donna Ciliska, National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada. Objectives: Health Evidence offers a suite of services tailored to the needs of Canada’s public health decision-makers by providing access to the best available evidence and related resources through health-evidence.ca and knowledge brokering services to promote evidence-informed decision making (EIDM) in Canada’s public health system. Methods: Support is offered through: Tailored (organizational, divisional, or team) capacity assessments for EIDM with practical recommendations; Standard and tailored workshops and presentations addressing EIDM ‘how to’; Customized knowledge brokering services to mentor individuals or teams in their EIDM practice, programs, and policy decisions, including: a) assessing capacity for EIDM and targeted brokering, b) supporting knowledge and skill development along the EIDM cycle, c) facilitating EIDM capacity development for key staff to lead other staff.

Results: User feedback facilitated enhancements to healthevidence.ca including: email campaigns tailored to users’ area(s) of interest, seven modifiable EIDM tools and resources to help public health organizations use research evidence in decision-making, and document and share lessons learned, 24 to 48 hour response turnaround for knowledge broker inquiries. Customized strategies to promote EIDM have been implemented at the local public health unit level, including oneon-one and team support for decision making on an as-needed basis (single/series; short/long term commitments). Four pilot EIDM capacity-building workshops, funded by the National Collaborating Centre for Methods and Tools, involved staff from 21 of 36 Ontario public health units. Conclusion: There is a strong demand for public health capacity development; staff are highly responsive to efforts to engage them in the EIDM process. Communicating Cochrane to Canada Lori Tarbett, Canadian Cochrane Centre, Ottawa, Canada. Background: Cochrane Canada relies on various methods to communicate its role and value in Canada. These methods must be continually updated, enhanced, or changed to promote and maintain Cochrane’s esteemed reputation and product use. Objectives: To inform healthcare workers, policy-makers, consumers and Canadian public of Cochrane’s practices and gold standard methodology medical evidence review; and about Cochrane Canada’s evidence utilization and author training. Methods: Canadian Cochrane Centre (CCC) uses/has used:

Intense promotion of pilot national license for The Cochrane Library Newsletter distribution (CCInfo – biweekly; developed and distributed globally on behalf of The Cochrane Collaboration; Relay Cochrane! - quarterly to over 2,200 Canadians; and Cochrane News - three times a year on behalf of the Collaboration ) Library Impact User Survey Library Anecdotal Impact Stories Media Releases Cochrane.org; ‘Cochrane Canada Live’ The CCC is also playing a lead role in hiring a communications firm to produce a Collaboration communications plan Library usage rose 90 per cent during the pilot

    

Results:

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Newsletter subscription continues to rise User Survey garnered over 1,200 responses with over 90 per cent of respondents agreeing the Library is a valuable; anecdotal stories were received from over 65 Canadians – this is used to help build a case for a national license in Canada Cochrane media coverage in Canada continues to rise ‘Cochrane Canada Live’ is successful with continuous hits from all over the world

Theme 2: Practical Effectiveness of vaccinating health care workers against influenza on the incidence of influenza and its complications in those 60 and older living in long term care facilities Roger E. Thomas, Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Canada; Tom Jefferson, Vaccines Field, The Cochrane Collaboration, Roma, Italy; Toby Lasserson, Scientific Editor, The Cochrane Library, Cochrane Editorial Unit, London. UK. Background: It is unknown whether vaccinating healthcare workers (HCWs) against influenza protects older people in longterm care facilities (LTCFs). Objectives: All studies of vaccinating HCWs, and influenza, complications and influenza-like illness (ILI) in individuals ≥ 60 in LCTFs. Methods: We searched CENTRAL (The Cochrane Library 2009, issue 3), (contain Cochrane Acute Respiratory Infections Group’s Specialized Register, MEDLINE (1966 to 2009), EMBASE (1974 to 2009) and Biological Abstracts and Science Citation IndexExpanded for RCTs and non-RCTs of influenza vaccination of HCWs in LTCFs. Two authors independently extracted data and assessed risk of bias. Results: Four C-RCTs (n = 7558) and one cohort (n = 12,742) study. Pooled data from three C-RCTs showed no effect on specific outcomes: laboratory-proven influenza, pneumonia or deaths from pneumonia. For non-specific outcomes pooled data from three C-RCTs showed HCW vaccination reduced ILI; data from one C-RCT that HCW vaccination reduced GP ILI consultations; pooled data from three C-RCTs reduced all-cause mortality in individuals ≥ 60. Conclusions: No effect was shown for specific outcomes: laboratory-proven influenza, pneumonia and death from pneumonia. An effect was shown for the non-specific outcomes of ILI, GP consultations for ILI and all-cause mortality in individuals ≥ 60. These non-specific outcomes are difficult to interpret because ILI includes many pathogens, and winter influenza contributes < 10 per cent to all-cause mortality in individuals ≥ 60. The key interest is preventing laboratory-proven influenza in individuals ≥ 60, pneumonia and deaths from pneumonia, and we cannot draw such conclusions. The identified studies are at high risk of bias.

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Conclusions: The CCC is a leader in communications across the Collaboration and continues to excel in this area. The AIM Study: Access, Innovation, and Medicines - Does Trade Improve Our AIM? Benjamin Warren, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada Background: Reforms to the current regime of intellectual property (IP) rights under international trade agreements are necessary. This research focuses on NAFTA. It was the first signed trade agreement to contain IP harmonization obligations. NAFTA Chapter 17 is based on a draft version of the TRIPS Agreement that existed at the time NAFTA was being negotiated. The TRIPS Agreement and NAFTA Chapter 17 are structured in a similar manner, cover more or less the same IP rights, and contain similar public health safeguard provisions. Objectives: The research aims to contribute to the literature by analyzing the lack of stakeholder consensus on the issue of how to best maintain incentives for drug R&D, while ensuring downstream access to medicines is not overly prohibitory. Methods: A Scoping Study was conducted following the approach advocated by Arksey, H. and O’Malley, L. (2005). Thematic analysis of current approaches to handling the study problem identified gaps in the existing literature on public health impact of IP harmonization in Mexico, as the developing country of interest. Results: NAFTA’s implementation in Mexico is the best case study we have on the subject of how harmonization of a developing countries’ IP system to an international standard has impacted access to medicines. Conclusion: Appropriate study designs to address future primary research questions in the research area were identified.

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Effectiveness of interventions to increase influenza vaccination rates in those 60 and older Roger E. Thomas, Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, Canada; Margaret L. Russell, Diane Lorenzetti, Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada. Background: The effectiveness of interventions to increase influenza vaccination rates in those ≥ 60 is uncertain. Objectives: Effects of interventions to increase influenza vaccination rates in those ≥ 60. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010, issue 3), containing the Cochrane Acute Respiratory Infections Group’s Specialized Register, MEDLINE (January 1950 to July 2010), PubMed (January 1950 to July 2010), EMBASE (1980 to 2010 Week 28), AgeLine (1978 to July 2010), ERIC (1965 to July 2010) and CINAHL (1982 to July 2010). Two reviewers independently assessed study quality and extracted data. Results: Forty-four RCTs were included: all studied seniors in the community and in high-income countries and none were societylevel interventions. Marked heterogeneity limited meta-analysis. Only five RCTs were graded at low and six at moderate risk of bias, including three of 13 personalized postcard interventions (all three with the 95 per cent confidence interval (CI) above unity), two of the four home visit interventions (both with 95% CI above unity, but one a small study), three of the four reminders to physicians interventions (none with 95 per cent CI above unity) and three of the four facilitator interventions (one with 95 per cent CI above unity, and one P < 0.01). The other 33 RCTs were at high risk of bias: no recommendations for practice can be drawn. Conclusions: Personalized postcards or phone calls are effective, and home visits, and facilitators, may be effective. Reminders to physicians are not. There is insufficient good evidence for other interventions. Sympathetic blockade using the Bier’s block technique for the treatment of chronic regional pain syndrome (CRPS): A systematic review Marc Rhainds, Martin Bussières, Mélanie Hamel, Martin Coulombe, UETMIS du CHUQ, Québec, Canada. Background: Intravenous regional sympathetic blockade (IVRB), called Bier’s block is used in pain management of CRPS. However, there is controversy about the benefits of the technique. Objectives: To assess the effectiveness and safety of the IVRB for the treatment of CRPS.

Methods: A literature search was performed to identify systematic reviews and randomized controlled trials (RCTs) assessing effectiveness and safety of IVRB. Safety evaluation was completed with narrative reviews, case reports, and retrospective studies. Primary outcomes were pain management and reduction of CRPS symptoms. Article selection, quality assessment, and data extraction were performed by two independent reviewers. Synthesis review was shared with a group of pain management experts. Results: Among the RCTs retrieved on the effectiveness, six were included. A total of four agents were studied (guanethidine, bretylium, methylprednisolone, clonidine). Heterogeneity was observed between RCTs regarding CRPS diagnosis criteria, population characteristics, technical parameters, and cotreatments. A number of serious methodological flaws were found in the RCTs. Based on the data available, it is unclear if the intravenous agents used to relieve pain in the treatment of CRPS are effective. The safety of IVRB was assessed throughout literature from RCTs, one retrospective study, and case reports. Adverse effects caused by intravenous agents, IVRB technique (tourniquet), and equipment failures were reported. In most cases, side effects were minor but some serious events were observed. Conclusions: Scientific evidence regarding the effectiveness of the IVRB is undetermined. Based on the lack of evidence, results do not support the use of IVRB in CRPS management. Can computerized clinical decision support systems improve practitioners’ diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review Pavel S Roshanov, Health Research Methodology Program, McMaster University, Hamilton, Canada; John J You, Department of Medicine, McMaster University, Hamilton, Canada; Hamilton Health Sciences, Hamilton, Canada; Jasmine Dhaliwal, Bachelor of Health Science Program, McMaster University, Hamilton, Canada; David Koff, Hamilton Health Sciences, Hamilton, Canada; Department of Radiology, McMaster University, Hamilton, Canada; Jean A Mackay, Lorraine WeiseKelly, Tamara Navarro, Nancy L Wilczynski, Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; R Brian Haynes, Department of Medicine, McMaster University, Hamilton, Canada; Hamilton Health Sciences, Hamilton, Canada; Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; for the CCDSS Systematic Review Team. Background: Underuse and overuse of diagnostic tests have

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important implications for health outcomes and costs. Decision support technology purports to optimize the use of diagnostic tests in clinical practice. Objective: To assess whether computerized clinical decision support systems (CCDSSs) are effective at improving ordering of tests for diagnosis, monitoring of disease, or monitoring of treatment. Methods: We searched, to January 2010, MEDLINE, EMBASE, Ovid’s EBM Reviews database, Inspec, and reference lists for randomized controlled trials comparing the use of CCDSSs to usual practice or non-CCDSS controls in clinical care settings. Trials were eligible if at least one component of the CCDSS gave suggestions for ordering or performing a diagnostic procedure. We extracted study methods, system and participant characteristics, and outcomes describing ordering or execution of diagnostic tests. Results: Thirty-four studies were identified. Thirty-three trials reported evaluable data on diagnostic test ordering and 55 per cent (18/33) of CCDSSs improved testing behavior overall, including 83 per cent (5/6) for diagnosis, 63 per cent (5/8) for treatment monitoring, and 35 per cent (6/17) for disease monitoring, and 100 per cent (3/3) for other purposes. Four of the systems explicitly attempted to reduce ordering rates and all succeeded. Costs, user satisfaction, and impact on workflow were rarely investigated or reported. Conclusions: Some CCDSSs can modify practitioner testordering behavior, but the determinants of success remain unclear. To better inform development and implementation efforts, studies should describe in more detail potentially important factors such as system design, user interface, local context, implementation strategy, and evaluate impact on user satisfaction and workflow, costs, and unintended consequences. Clinical Use Evidence Summaries (CUES) for knowledge translation: Preliminary survey of clinicians on the development of focused clinical question and answer summaries based on Cochrane Reviews Douglas M Salzwedel, James M Wright, Christopher Adlparvar, Ciprian Jauca, Balraj S Heran, Gavin WK Wong, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada. Background: Cochrane Reviews are increasingly being

translated into products aimed at specific audiences, including primary care clinicians. Additional tools are needed to assist time-challenged practitioners in improving their access to evidence-based answers to clinical questions and to facilitate author-practitioner knowledge exchange. Creation of these tools necessitates the active involvement of clinicians in the development phase. Objectives: To develop a template for clinical question and answer summaries designated CUES; to describe the results of a survey used to develop the template; and to outline a proposed study evaluating the effectiveness of evidence summaries of Cochrane reviews. Methods: Clinicians participating in a Cochrane Review group workshop, as well as those receiving a quarterly evidence-based therapy newsletter, will be asked to complete a user needs survey designed to inform the creation of a template for presenting focused clinical question and answer evidence summaries drawn from the results of Cochrane Reviews. Survey questions will address preferred evidence summary formats, headings, content, subject priorities and length. Interested clinicians will be invited to participate in a study evaluating the effectiveness of the evidence summary template in translating the results of a sample of Cochrane to practitioners. Study participants will be pre- and post-tested on knowledge gained from information presented in a selection of CUES. Results: The results of the preliminary survey will be reported in February 2011. Design and development of the pre-post study to be carried out in mid-2011 will be described in further detail. Conclusions: Effective development of evidence summaries for primary care clinicians requires the active participation of the target audience in the process. The results of the survey and evaluation of the pre. Just say NO to scientific poster boards (A plea for e-posters at conferences) Aaron M Tejani, Chris Adlparvar, Cochrane Hypertension Review Group, Vancouver, Canada; Sarah Stabler, University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, Canada; Erin Schenger, UBC Faculty of Pharmaceutical Sciences, Vancouver, Canada. Background: Professional conferences (e.g. the Cochrane Colloquium) most often have a poster session where members present their work on a two-dimensional three foot by five foot poster. The poster display rooms are typically lined with approximately 10-30 large stands in order for the posters to be displayed. Look around you and you will see what we are referring to. Posters typically cost at least $100 to print (maybe more if they are laminated), are outdated as soon as new information regarding the ‘work’ being displayed is available, and

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have little use after being displayed at a conference. This seems like a significant waste of human, financial, and environmental resources. Objective: The sensible alternative is to move toward electronic posters (e-posters). E-posters have several benefits. Proposed benefits: First, they are arguably more visually appealing and interactive than large paper posters as presenters can use video, audio, and animation. Second, they require limited environmental resources as no print materials are wasted. Third, e-posters are more likely to be used at different conferences as they can be updated with new information unlike the traditional posters. Many professional conferences already use this method successfully such as the American Society of Clinical Oncology and the European Society of Pediatric Infectious Diseases. We will demonstrate simple techniques, tools, and software that can be used to create e-posters and provide examples of what well made e-posters look like. Conclusions: If sharing up-to-date knowledge, engaging professionals, and not wasting resources are the goals, conference organizers should move toward e-poster sessions. Evaluation of an innovative consumer-researcher partnership model to promote accessible and practical research: CARES (collaborations, answers, respect, education, and support) Allen J Lehman, Colleen Maloney, Nadia Prestley, Gordon Whitehead, and the Consumer Advisory Board (CAB); Arthritis Research Centre of Canada, Vancouver, Canada. Objective: To evaluate the CARES model of consumerresearcher partnership: 1) research relevance for consumers, 2) knowledge translation (KT) activities, and, 3) quality of research. Methods: Effectiveness of the CARES model was evaluated among eight arthritis researchers and seven consumers who had utilized the model in < 12 months. CARES was previously developed by the Consumer Advisory Board (CAB) and the Arthritis Research Centre of Canada. CARES serves to guide consumer-researcher collaborations by providing meaningful answers through respect, education, and support. Effectiveness was assessed using Likert-style questions assessing the degree to which participants disagreed=1 or agreed=7 with statements regarding consumer-researcher collaborations; written statements were also collected. Descriptive and content analyses were conducted to identify perceived effectiveness and common themes. Results: Mean researcher and consumer ratings were high for collaborations improving research relevance (6.5 vs 6.9), KT (6.1 vs 6.7), and research quality (6.4 vs 6.4). Common themes among researchers included: making research more innovative, competitive, and clinically relevant; improving KT strategies

to identify and reach stakeholders; and, increasing consumer relevance of research by refining research priorities and using consumer insight for data collection/interpretation. Common themes among consumers included: increasing breadth and depth of knowledge, enriching content of research questions, developing KT activities to bridge gaps between researchers and the public; and, shaping research agendas through consumer expertise. Conclusions: The CARES model offers practical guidelines for health researchers seeking to effectively involve consumers as research partners. CARES offers an approach to enhance KT activities by making credible and practical research accessible to stakeholders. The application of Cochrane Review at WorkSafeBC: Policy Item # 15.50 and 15.51 (on hernia) as an example Craig Martin, Celina Dunn, Peter Rothfels, Gayle Pelman, Kukuh Noertjojo, WorkSafeBC, Richmond, Canada. Background: Policy Item # 15.50 and 15.51 on hernia on WorkSafeBC‘s Rehabilitation Services and Claim Manual was developed in the mid 1980’s. This policy, which was developed by employing expert consensus, described various aspects of inguinal hernia including duration of return to work. This policy gives front line staff direction on how to deal with claims involving hernias. Access to The Cochrane Library in the early 2000’s revealed a large discrepancy between the outcome of the Cochrane Review on hernia and Policy Item # 15.50 especially on duration of post-operative time off work. Objectives:

To describe the application of evidence-based medicine (EBM) at WorkSafeBC through the work of the EvidenceBased Practice Group, Clinical Services, in policy development, role of The Cochrane Library, and the dissemination of EBM by WorkSafeBC. To update the Cochrane Review on inguinal hernia focusing on duration of return to work. To investigate the impact of changes in Policy Item # 15.50 and 15.51 since 2004 in claim outcomes, costs and duration of post-operative return to work for inguinal hernia related claims. 2002 Cochrane Review on inguinal hernia repair will be updated focusing on duration of post-operative return to work. Outcomes on hernia related claims will be analyzed as a

Methods:

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before (1999-2003) and after (2004-2008) analysis. Results: Systematic review update on inguinal hernia postoperative return to work and evaluation on hernia claim outcome swill be presented. Academic Detailing: The BC Experience Terryn Naumann, Anne Nguyen, Sarah Jennings, Kelly Grindrod, Suzanne Taylor, Pharmaceutical Services Division, BC Ministry of Health Services, New Westminster, Canada. Background and Objectives: The BC Ministry of Health Services’ Pharmaceutical Services Division (PSD) has established a successful academic detailing service which aims to provide objective, balanced, evidence-informed drug information to physicians and other health care professionals on the best prescribing practices. Methods: The BC Provincial Academic Detailing (PAD) service was launched in March 2008. Funding is provided by PSD to regional Health Authorities and the University of British Columbia’s eHealth Strategy Office. Drug therapy topics are recommended by an advisory committee. Each topic is developed in consultation with an independent clinical expert who writes a newsletter article, teaches part of an accredited upskilling workshop and reviews other printed materials/ tools. Each topic is accredited for 1.0 Mainpro-M1 continuing education credit. Evaluation of PAD involves a mixed-methods approach with qualitative surveys, focus groups, interviews and a quantitative assessment enabled by a designed delay, clustered randomization process and use of the provincial health databases. Technology enabled academic detailing (TEAD) sessions have been introduced allowing academic detailing sessions to be conducted via web conferencing. Results: To date, the PAD service has provided academic detailing sessions on HPV vaccination, anticoagulation in atrial fibrillation, antibiotics in community practice, inhaled medications for chronic obstructive lung disease and medications for osteoporosis. As of October 2010, PAD has 11 (9.0 FTEs) academic detailing pharmacists. Over 1,100 physicians and other health care professionals have participated in at least one session. Conclusion: The BC PAD service makes practical drug information more accessible to physicians and other health care professionals.

A Tool to Assess Learning Needs to Inform Content Development and Plan Continuing Medical Education Carol Repchinsky, Denice Lewis, Barbara Jovaisas, Pierre Pluye, Roland Grad, Charo Rodriguez, Bernard Marlow, JoAnne Hutsul, Geoff Lewis, Marc Riachi, Helene Perrier, Angela Ross Background: The Canadian Pharmacists Association (CPhA) publishes e-Therapeutics+, a regularly updated electronic information resource of evidence-based treatment recommendations. The Information Assessment Method (IAM) is a validated tool that documents self-reported “reflection on relevance, cognitive impact, use and health outcomes” of information objects delivered by email. Objective: To explore whether e-Therapeutics+ information delivered via email with the IAM questionnaire can be used to identify learning needs of family physicians for content development and CME programming. Methods: The design was a Web-based survey. Participants were members of the College of Family Physicians (CFPC). The highlights are green text embedded within a chapter. These highlights were selected as appropriate for family physicians in consultation with CFPC. Results: A mean of 680 ratings per highlight was recorded over 22 weeks. Mean scores referring to learning (I learned something new) of 54 per cent, motivation (I am motivated to learn more) of 46 per cent and relevance of 50 per cent were documented for the 22 highlights. A graph comparing these ratings for each highlight shows variance among the three scores for some topics, e.g., high relevance score but low learning score. Conclusion: Using externally guided reflection, the IAM questionnaire attached to e-Therapeutics highlights may provide useful information for assessing the learning needs of family physicians, planning CME programs and for developing new content for the electronic publication. Interpretation of the data will be sought from continuing professional development informants during this ongoing study.

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Using web-based tools to facilitate production of a systematic review Angela Busch, University of Saskatchewan, Saskatoon, Canada; Candice Schachter, University of Saskatchewan, Windsor, Canada; Tom Overend, University of Western Ontario, London, Canada; Mary Brachaniec, Moncton, Canada; Rachel Richards, North Vancouver, Canada; Julia Bidonde, Vanina Dal Bello-Haas, Sandra Webber, University of SK, Saskatoon, Canada; Adrienne Danyliw, Health Quality Council, Saskatoon, Canada; Anuradha Sawant, London Health Sciences Center, London, ON, Canada. Background: As review teams expand and become geographically dispersed, effective collaboration may be challenged. When our Cochrane Review team grew to include 10 people from across Canada, a number of web-based tools were employed to facilitate the collaborative processes needed to support the search strategy, data extraction and verification, decision-making, and refinement of methods. Objective: To share our experiences using web tools to assist a large systematic review team. Methods: Our review, Exercise for Fibromyalgia, involved six interventions and 24 outcome variables (most measured using continuous scales) complicating data extraction and verification processes. In addition to Cochrane’s web-based systematic review tools (Archie, RevMan, the Cochrane Handbook for Systematic Reviews of Interventions) and bibliographic databases (RefMan) and indexes, we sought and used a variety of freely accessible web-based tools to overcome challenges related to organizing and conducting a review with 10 team members in six cities and four time zones. Trial Stat was initially provided free of charge to systematic reviewers to facilitate independent review and classification of citations and abstracts. Skype web-conferencing provided the vehicle for team meetings. A WIKI (a mass collaborative authoring tool) was used to share historical and resource documents. Google Docs, another web-based application, was used for shared file storage and real-time collaboration using Microsoft Office-compatible document formats. Special features of Google Docs facilitated dual-reviewer data extraction and verification. Results and Conclusion: Through trial and error, our team identified a set of web-based tools to enable cohesion and effective collaboration in a geographically-dispersed group of systematic reviewers.

Botulinum toxin for subacute/chronic neck pain Charlie H. Goldsmith, Department of Clinical Epidemiology and Biostatistics, Biostatistics Unit, St Joseph’s Healthcare, McMaster University, Hamilton, Canada; Pierre Langevin, Departement de Réadaptation, Faculté de Médecine, Université Laval, Québec, Canada; Janet.E. Lowcock, Chicago, USA; Jeffrey Weber, Department of Physical Therapy, University of Alberta, Edmonton, Canada; May M Nolan, School of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Anita R.Gross, School of Rehabilitation Science, McMaster University, Hamilton, Canada; Paul M Peloso, Clinical Development Analgesia and Immunology; Merck Rahway, New Jersey, USA; John P. Roberts, Calgary, Canada; Nadine Graham, School of Rehabilitation Science, McMaster University, Hamilton, Canada; Stephen J Burnie, Canadian Memorial Chiropractic College (CMCC), Toronto, Canada; Ted Haines, Department of Clinical Epidemiology and Biostatistics, McMaster University Hamilton, Canada. Background: Botulinum Toxin (BoNT) intramuscular injections are often used with the intention of treating neck pain (NP). Objectives: To systematically evaluate the literature on the treatment effectiveness of BoNT on pain, disability, global perceived effect and quality of life in adults with NP with or without cervicogenic headache. Methods: We searched CENTRAL, MEDLINE, CINAHL, and EMBASE from their origin to 20 September 2010 for randomised controlled trials where BoNT injections were used to treat NP. A minimum of two authors independently selected articles, abstracted data, and assessed methodological quality. We calculated standard mean differences (SMD) and relative risks, and performed meta-analyses. An overall grade of the quality of the evidence was presented. Results: High quality evidence suggests BoNT-A was no better than saline at four weeks [five trials; 252 participants; SMDpooled -0.07(-0.36 to 0.21)] and six months for chronic NP. Very low quality evidence indicated that BoNT-A combined with exercise and analgesics was not significantly better for patients with chronic NP at four weeks [two trials; 95 participants; SMDpooled 0.09 (-0.55 to 0.73)] and six months compared to saline. Very low quality evidence (one trial, 32 participants) showed that BoNT-A was no better than saline at four weeks and six months for cervicogenic headache. Conclusions: Current evidence does not confirm a significant benefit of BoNT-A on subacute/chronic NP at four weeks and six months. Larger trials with predefined subgroup analyses to identify predictors of responses and designs that explore BoNT-A as an adjunct treatment to exercise and analgesics are needed.

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How effective are interventions used in the beef processing industry for decreasing Escherichia coli on beef carcasses? A systematic review and meta-analysis of the existing literature Judy Greig, Barbara Wilhelm, Janet Harris, Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Guelph, Canada; Lisa Waddell, Ashley Farrar, Andrijana Rajic, Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Guelph, Canada and Department of Population Medicine, University of Guelph, Guelph, Canada; Wendy Wilkins, Sarah Parker, Department of Large Animal Clinical Sciences, University of Saskatchewan, Saskatoon, Canada; Oliver Butcher, Laboratory for Foodborne Zoonoses, Public Health Agency of Canada, Guelph, Canada and Department of Population Medicine, University of Guelph, Guelph, Canada. Background: Beef processing research has focused on development of interventions to effectively decrease levels of pathogenic organisms on carcasses. Objective: Using systematic review methodology, the study objective was to evaluate the effectiveness of interventions applied to beef cattle from the farm to completion of carcass chilling, to reduce E. coli on carcasses. Methods: Implementation of a search strategy on four electronic databases identified 57 studies (experimental or observational) representing original English research reporting prevalence and/or concentration of E. coli on beef carcasses under field conditions. Data extraction captured information related to study methodology and reporting, population characteristics, intervention details, laboratory methods, outcomes and statistical methods. Random effects meta-analysis estimated the effect of post-evisceration washing, pasteurization and chilling on E. coli concentration and the odds of a contaminated beef carcass. Analyses were sub grouped by outcome type (concentration data) and intervention type (dichotomous data). Possible sources of heterogeneity were identified a priori and explored as data quantity allowed. Results: Meta-analysis results for carcass washes, pasteurization and chilling will be presented as forest plots. Conclusions: Pasteurization has been demonstrated to be an effective intervention against E. coli; variations in the method were not statistically heterogeneous. Three studies indicated that chilling has a protective effect. Well designed large studies on this topic are lacking, particularly control trials. Public

accessibility to data is hampered by the proprietary nature of information held by processors. Results will serve as inputs for risk assessment and predictive modeling promoting sciencebased decision-making and policy development in the area of food safety. Assessing the prognostic value of technetium-99m in coronary artery disease screening with myocardial perfusion imaging in asymptomatic patients with type 2 diabetes: A systematic review Azim Kasmani, Shannon Kelly, Canadian Agency for Drugs and Technologies in Health (CADTH)/University of Ottawa, Canada; Tammy Clifford CADTH, Ottawa, Canada; Doug Coyle, University of Ottawa, Ottawa, Canada. Background: The consistent availability of medical isotopes, including technetium-99m (Tc-99m), has become an issue with the closure of nuclear reactors in Canada and the Netherlands. Coronary artery disease (CAD) is the leading cause of death amongst patients with diabetes and myocardial perfusion imaging (MPI) using Tc-99m is commonly used to detect CAD in patients with type-2 diabetes mellitus (T2DM). Objectives: To determine the prognostic value of Tc-99m MPI screening for CAD in asymptomatic patients with T2DM through a systematic review of the available literature. Methods: Peer reviewed literature searches were conducted in a broad range of bibliographic databases including: MEDLINE, EMBASE, The Cochrane Library, PubMed, and others; grey literature was identified through the CADTH Grey Matters procedure. Inclusion criteria incorporated adult patients asymptomatic for CAD with T2DM; Tc-99m MPI screening for CAD; and cardiac related death, myocardial infarction, or revascularization as outcomes. Randomized trials and observational studies were included from 1990-present. Citations and studies were reviewed by two independent reviewers for inclusion. Alerts were set up to identify new studies as they become available. Results: Eight observational studies and two randomized trials have been identified for inclusion in initial results. Due to the potential for bias in observational trials, a meta-analysis was not deemed appropriate. Overall, the observational studies show some benefit for prognostic screening; randomized trials show no significant difference between screening and no screening. Conclusions: Tc-99m MPI may be a valuable prognostic tool for detecting asymptomatic CAD in T2DM patients. Further randomized trials are required to confirm this.

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Theme 3: Credible A Cochrane systematic review of system-wide interventions to improve the use of thromboprophylaxis: Methodology and preliminary results Jacqueline Cohen, McGill University, Montreal, Canada; David R Morrison, Ian Shrier, Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Canada; Susan R. Kahn, McGill University, Jewish General Hospital, Montreal, Canada; Jessica Emed; Vicky Tagalakis, Jewish General Hospital, Montreal, Canada. Background: Prophylactic therapies for venous thromboembolism (VTE) are effective and safe, yet, underutilized. There are many proposed strategies to increase the use of thromboprophylaxis and we sought to determine their effectiveness in a systematic review of system-wide interventions to improve the use of appropriate thromboprophylaxis. Objectives: Systematically review studies designed to assess the effectiveness of interventions aimed at increasing the use of thromboprophylaxis. Methods: We sought to capture studies which utilized an intervention to improve prescribing of appropriate prophylaxis. We searched MEDLINE, EMBASE, and SCOPUS databases and reference lists of included studies and published reviews. Article eligibility assessment and data extraction were done in duplicate. Extracted data included study design, setting, intervention and outcomes including proportions receiving appropriate prophylaxis, incidence of VTE, and safety outcomes including major bleeding. Risk of bias was assessed using Cochrane guidelines. Data were entered into separate databases and compared for agreement. Results: Fifty-seven studies were included. Studies included a mix of randomized and non-randomized studies, the vast majority non-randomized. Types of intervention varied greatly and were aimed at different actors in the hospital. We obtained data on the proportion of appropriate prophylaxis for most studies. Rates of VTE were sometimes available; however, data for safety outcomes were less often reported. Conclusions: Numerous studies have assessed interventions designed to improve the use of thromboprophylaxis. This review will facilitate knowledge translation regarding which interventions designed to reduce avoidable VTE are effective. More conclusions to come when the quantitative analyses are completed in the coming months.

Which is the better source of evidence – RCT or program evaluation? - Lessons from a provincial project on bariatric treatment strategies Bing Guo, Christa Harstall, Institute of health Economics, Edmonton, Canada. Background: One of the current trends in the field of health technology assessment (HTA) is that health policy decisions have to be made within a complex context in which a significantly heterogeneous population is managed by multiple intervention strategies. Obesity is a chronic, epidemic condition that affects all age groups. The various stages of overweight and obesity defined by the body mass index and obesity related comorbidities requires treatment strategies usually in combination that fall into five broad categories: dietary therapy, physical exercise, behavioural therapy, pharmacology, and surgery. Objective: To describe our experience of undertaking a provincial project requested by the Health Ministry on the comparative effectiveness of various bariatric treatment strategies for the treatment of obese people. Methods: With a tight time-line of 90 days, an overview of systematic reviews/HTAs of randomized controlled trials (RCTs) was planned. Although, originally suggested by the HTA researchers, program evaluation studies were excluded during negotiations with the government. The workplan produced by HTA researchers was reviewed, modified, and approved by the clinical experts on the advisory committee established by the government. Results: When the draft final report was presented to the advisory committee, clinical experts raised concerns about omissions of key components, implementation issues, and longterm outcomes within a comprehensive weight management program. Evidence from RCTs was insufficient to address these concerns. Conclusions: Opportunities for education and understanding operational impact questions need to occur outside of the project’s time-lines. Improving policy makers’ understanding about the most appropriate source of evidence is essential.

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Cochrane Canada 9th Annual Symposium

Time use by healthcare aides in nursing homes: A pilot study Anastasia A. Mallidou, Greta Cummings, University of Alberta, Edmonton, Canada; Corinne Schalm, Shepherd’s Care Foundation; Alberta, Canada; Carole Estabrooks, University of Alberta, Edmonton, Canada. Background: Healthcare aides (HCAs) are the primary caregivers in residential long term care (LTC) facilities. Their time use has not been adequately investigated, even though there is evidence that adequate human resources are associated with performance, innovation, quality of care, and caregiver and resident outcomes. Objectives: To understand how HCAs spend their working time with residents during dayshifts in a LTC unit and to measure potential changes in time spent with residents, caregiver satisfaction, and resident incidents (e.g. falls) during the study period. Methods: In this observational exploratory pilot study, a convenience sample of nine HCAs employed in a LTC unit in Edmonton consented to participate. Data were collected using structured observations, semi-structured interviews, a short survey, and other sources (e.g., incident book). During nine weeks in a six-month period, one - four HCAs were shadowed for five - eight hours/dayshift during working days (approximately 700 hours in total) on time spent in: personal care, assisting with eating, socializing, paperwork, networking, and other (e.g. travel time). Results: Over 50 per cent of HCAs’ working time is spent in resident personal care with 35 per cent of time spent in performing one - three minute activities; less than one per cent in socializing; and 23 per cent spent on other activities. At the end of the observational period, HCAs reported higher levels of job satisfaction, while resident falls decreased. Conclusions: Restructuring some portion of HCAs’ routine practices may minimize the one - three minute activities, which can be interpreted as interruptions to continuity of care. Fewer interruptions may allow HCAs to use their time with residents more effectively.

The Therapeutics Letter as a source of evidence based information promoting Cochrane methodology and reviews Vijaya Musini, James Wright; University of British Columbia, Vancouver, Canada. Background: Cochrane Reviews are internationally recognised as the highest standard in evidence-based health care. No other organisation matches the volume, scope and range of healthcare topics addressed by Cochrane Reviews. In contrast to authors that pool research supporting their opinion or prejudices for commercial interest, a Cochrane Review uses a predefined, rigorous and explicit methodology. Besides The Cochrane Collaboration, there are several other groups providing evidence based information regarding drug therapy. The Therapeutics Initiative (TI) is an example of an independent group publishing unbiased assessment of evidence on effectiveness of drug therapy in their Therapeutics Letter. Objectives: To document the use of Cochrane methodoloy (meta-analyses, risk of bias tool); RevMan software; and reviews from The Cochrane Library in the TI Letters. Methods: Seventy-seven TI Letters published on the website www.ti.ubc.ca were carefully read to document use of Cochrane methodology; RevMan software to meta-analyse data; and referencing of Cochrane Reviews. Results: Of the 77 TI letters published till date since 1994, Cochrane methodology and RevMan software was first used in 2001 and in 16/39 (41 per cent) letters published since then. The new Cochrane risk of bias tool was specifically used in recent 3/5 (60 per cent) letters since 2009 (# 71, 73 and 77) to aid in interpretation of the evidence. Cochrane Reviews were first referenced in 1997 and are cited in 20/61(33 per cent) letters published since then. Conclusions: Increasing use of Cochrane methodology, Revman software and Cochrane Reviews in TI letters helps both to promote use of The Cochrane Library and emphasize the value and credibility of Cochrane Reviews. Outliers; do they represent trials with a high or low risk of bias? VM Musini, MI Perez, JM Wright, Cochrane Hypertension Review Group, Vancouver, Canada; F Gueyffier, Cochrane Hypertension Review Group, Lyon, France. Background: Outliers found in a funnel plot of a meta-analysis may indicate potential bias in those trials. Objectives: To determine whether outliers in a funnel plot represent RCTs with low or high risk of bias. Methods: Critical analysis of outlier RCTs in a meta-analysis. Results: A large meta-analysis studying nitrates given within 24

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hours of the onset of a myocardial infarction revealed that they significantly reduced all-cause mortality at 10 days (RR 0.91, 95 per cent CI [0.86,0.96]; I2 =46 per cent) compared with placebo. Two studies out of 16 were outliers. Removing these trials reduced heterogeneity from I2 =46 per cent to 0 per cent, but did not change the overall effect size. Careful analysis of those two trials revealed that both had something in common. They were not double blind and they used stopping rules to terminate the trial. In Durrer trial, the stopping rule “was not designed to determine whether nitroprusside was worse than placebo”, so, it ended when there were more deaths in placebo group. The Jugdutt trial was suspicious in that a publication stated that the total number of randomized patients was 278, but in other publication this number was 310. All of the additional 32 patients were added to the placebo arm, and 40 per cent of the added patients died. Although we included results of these two trials, it was clear to us that they had high risk of bias, because they were not blinded and were stopped early. Conclusions: In this meta-analysis, outliers turned out to have a high risk of bias. Plastic adhesive drapes for surgical site infection (SSI) prevention: Using Cochrane evidence in health decisions in a university hospital Marc Rhainds, Martin Coulombe, UETMIS du CHUQ, Québec, Canada. Background: In 2009, a Cochrane Review was published on the use of plastic adhesive drapes during surgery for preventing SSI. The Health technology assessment unit of the Quebec university health center was asked by an operating room nurse to review the evidences and the impact on the clinical practice. Objectives: To describe a knowledge transfer experience using a Cochrane Review in health decisions. Methods: Quality of the Cochrane Review was evaluated independently by two reviewers. A literature search was conducted to identify other systematic reviews and guidelines. Synthesis review and impacts of the evidences on operating room procedures were discussed in our hospital with experts in surgery, infection control, and nursing. Results: The Cochrane Review and a NICE guidance identified from the literature search were assessed. There was no evidence that plastic adhesive drapes reduce SSI rates and some evidence that they increase infection rates. Experts discussed evidence and their appraisal brought considerations about other purposes of using plastic drapes not assessed in the reviews such as maintenance of the wound integrity. Based on the Cochrane Review and local context in our hospital, experts recommend that universal use of plastic adhesive drapes is no longer required but should be supported by the surgical team

decision according to patient characteristics and type of surgery. Conclusions: Our experience suggests that using Cochrane systematic reviews to support health decisions is helpful but complementary processes are required to appraise their impacts and applicability on the clinical practice. Is Your Mom on Drugs? – Ours Was and What We Did About It Johanna Trimble, BC Patient Voices Network, Vancouver, BC, Canada Background: Following admittance to a Care Centre, our Mom experienced a precipitous mental status decline and was diagnosed with Alzheimer’s. Objectives: This rapid decline without forewarning convinced us that our 87-year-old Mom was over-medicated as several new drugs had been prescribed. We wanted to convince health care staff to direct a reduction in drugs. Methods: We used internet searches to locate credible information about adverse drug effects: The Cochrane Collaboration, UBC’s Therapeutics Initiative, the Beer’s List, worstpills.org, geriatric nursing sites, etc. We suspected anti-cholinergic drugs and serotonin syndrome were resulting in cognitive impairment. We heeded Dr John Sloan, who has worked exclusively with the frail elderly. He discussed the “evidence-free zone” regarding multiple drugs and how guidelines-driven prescribing can increase risk for this population. Family cohesiveness, persistence, and remaining respectful with healthcare staff when frustrated by the “system” are vital. The family is the expert, recognizing what is normal for this family member. Medical staff are often meeting this patient for the first time. Spending time allows the family to hear information staff haven’t time for and may dismiss as insignificant, to the detriment of medical care. Results: The staff agreed to direct a drug reduction and our Mom made a remarkable recovery from “Alzheimer’s”. Conclusions: We believe we extended and improved the quality of our Mom’s life. Given constant media coverage of the “epidemic of Alzheimer’s and dementia” we need to look more carefully at the epidemic of over-medication first, saving much suffering and reducing health care spending.

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Cochrane Canada 9th Annual Symposium

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Fairmont Pacific Rim

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Fairmont Pacific Rim

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Cochrane Canada