​Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite

Mammalian bite wounds are a very common clinical problem across the world. Systematic reviews have been conducted to address the role of education in preventing dog bite injuries in adolescents and children (Duperrex 2009) and antibiotic prophylaxis for mammalian bites (Medeiros 2001). However local wound management, one of the most important aspects in management of mammalian bites has not been evaluated by systematic reviews. The issue of primary closure versus delayed closure for non-bite traumatic wounds has been studied previously (Eliya-Masamba 2013), but this systematic review did not include mammalian bites. The issue of primary closure of animal bites remains controversial (Garbutt 2004), and a systematic review in this regard will help to make an objective assessment of this important question, and enable evidence-based clinical decision-making and guideline development.

A Cochrane Review on this is being conducted by Dr. Soumyadeep B and his colleagues. The protocol for the same has been published and is available here  (Open Access in India by ICMR grant )

Ethics and equity in research priority-setting: stakeholder engagement and the needs of disadvantaged groups

A transparent and evidence-based priority-setting process promotes the optimal use of resources to improve health outcomes. Decision-makers and funders have begun to increasingly engage representatives of patients and healthcare consumers to ensure that research becomes more relevant. However, disadvantaged groups and their needs may not be integrated into the priority-setting process since they do not have a “political voice” or are unable to organise into interest groups. Equitable priority-setting methods need to balance patient needs, values, experiences with population-level issues and issues related to the health system.
Read the full paper published by Dr. Soumyadeep B et al at Indian Journal of Medical Ethics here (Click: Open Access)

Too much medical research may be unnecessary, unethical, unscientific, and wasteful, warns new international research network

Researchers, research funders, regulators, sponsors and publishers of research fail to use earlier research when preparing to start, fund or publish the results of new studies. To embark on research without systematically reviewing evidence of what is already known, particularly when the research involves people or animals, is unethical, unscientific, and wasteful.

To address this problem a group of Norwegian and Danish researchers have initiated an international network, the ‘Evidence-Based Research Network’ (EBRNetwork). The EBRNetwork brings together initial partners from Australia, Canada, Denmark, the Netherlands, Norway, the UK, and USA was established in Bergen, Norway in December 2014. It also has members from low and middle income nations like India, South Africa and Brazil.

At the ‘Bergen meeting’ partners agreed the aim of the EBRNetwork is to reduce waste in research by promoting:

No new studies without prior systematic review of existing evidence

Efficient production, updating and dissemination of systematic reviews

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Logo of the new Evidence Based Research Network

My take : In real terms this signifies a tactical shift of the way medical research is conducted and funded globally and bring in more objectivity into funding decisions . The current system of research funding is flawed and decisions are often not on the scientific need of the research to be conducted but on peer-perceptions. It will also prevent policy makers to be mis-guided by scientist who are prone to hype their own agenda for causes of career progression.

Note : The information provided here is adapted from the press release by network together with some personal opinions.  Dr. Soumyadeep Bhaumik is one of the members of the network.

Identifying Research Priorities and Setting Research Agenda in Clinical Toxinology with a Focus on Snake Envenomation

“Identifying Research Priorities and Setting Research Agenda in Clinical Toxinology with a Focus on Snake Envenomation” was the theme of the round table discussion at the Toxinological Society of India Conference 2014 held at Calcutta School of Tropical Medicine on November 22 2014.

Theme lecture on Identifying Research Priorities and Setting Research Agenda was delivered by Dr. Soumyadeep Bhaumik, Cochrane Agenda and Priority Setting Methods Group, & BioMedical Genomics Centre, Kolkata, India

Health Research priority setting processes enable policy-makers, researchers, clinicians and public health professionals to effectively use available resources to collectively decide on what problems or uncertainties are worth trying to resolve/understand for maximal benefit. A transparent and evidence based priority setting process not only helps prioritization but also puts in perspective of patients and the need to improve health outcomes and reverse inequity. Snakebites, a neglected tropical condition, affects millions and kills thousands and yet there is miniscule research in this arena. The presentation focused on the basic concepts of research priority setting exercise, its utility and methods and processes for identifying research gaps and setting research agendas including question formulation, evidence assessment and prioritization process.

The presentation is available here Identifying Research Priorities & Setting Research Agenda. (Click)

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The Round Table discussion that followed had the following discussants

1. Professor Y K Gupta (Chair), Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), New Delhi,India
2. Professor Yuri N. Utkin, Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russia
3. Professor Chittaranjan Maity, Head of the Department, Department of Biochemistry,KPC Medical College,Kolkata,India
4. Professor Antony Gomes, Laboratory of Toxinology and Experimental Pharmacodynamics, University of Calcutta, Kolkata,India
5. Professor Juan J Calvete, Laboratorio de Venomica , Estrtuctural y Funcional Instituoto de Biomedicina de Valencia, Spain
6. Dr Soumyadeep Bhaumik, Cochrane Agenda and Priority Setting Methods Group, & BioMedical Genomics Centre, Kolkata, India
7. Professor Santanu K Tripathi (Rapporteur for Toxinological Society of India). Head of the Department , Clinical & Experimental Pharmacology, Calcutta School of Tropical Medicine, Kolkata,India

The discussion focused to understand how priority setting processes can be inculcated in the field of snake envenomation and what broad domains can be considered priorities, as well as the ways to deal with challenges to development and implementation of research agenda in snake envenomation .

Please visit :  http://capsmg.cochrane.org/ for more details and resources on setting research agendas and identifying research priorities.

Developing evidence based health policy in resource limited settings—lessons from Nepal

Few would argue against the benefits of evidence informed public health and health policies. However, efforts to inform health policy in resource limited settings face particularly daunting challenges—often specific to the political complexity and resource limitations experienced uniquely in low and middle income countries (LMICs).

The Nepal Health Research Council (NHRC), a Government of Nepal body, has a long held mandate to support informed decision making by health policymakers in Nepal—an exciting but daunting role to operationalise. Informing health policy assumes that there is a base of information to communicate: in Nepal, this often isn’t available.

Read the full article by Dr Sangeeta R, Dr. Soumyadeep B and Dr. Krishna A at the British Medical Journal Blogs (Open Access)

Mapping the growth of The Cochrane Collaboration in India

The Cochrane Collaboration held its annual Colloquium for the first time in South Asia at Hyderabad , India in September 2014. Dr. Soumyadeep B presented a poster to analyse the growth of The Cochrane Collaboration in India. As a vehement supporter of open data the poster is also made available here. The same will also be archived at the 2014 Colloquium Official website. Click on link below or the Image for downloading a pdf of it.

Mapping the growth of The Cochrane Collaboration in India

Regional distribution of Cochrane Contributors in India (Click o Image for Full poster)
Regional distribution of Cochrane Contributors in India (Click on Image for Full poster)

Perspective of different stakeholders in research priority setting for a public health problem in low and middle income nation

The 22nd Cochrane Colloquium in Hyderabad saw a special session on “Setting research agendas: balancing public health and patient level priorities” on 25th September 2014,  . The session organised by the Cochrane Agenda and Priority Setting Methods Group (CAPSMG)  had the following format :

Session Co-Chairs  Roberto D’Amico & Damian Francis

Rebecca Armstrong: Priority setting: the CPHG experience

Robert Dellavalle & Chante Karimkhani :On the Global Burden of Disease project and how it can help set priorities vis-a-vis public health and patient level priorities

Soumyadeep Bhaumik : Perspective of different stakeholders in a  research priority setting of a public health problem in LMIC

Kevin Pottie: Priority Setting for Guidelines and Interventions

Vivian Welch: Cochrane Agenda and Priority Setting Methods Group (CAPSMG)

Discussion Session : ROLE PLAY where participants took roles as policy makers, clinicians and members of the public for deciding priority for Ebola and Sin taxes for Sugar Sweetened Beverages. 

Dr. Soumyadeep B presentation at the session is attached and free to use under CC-BB-NY-SA (Click)

Perspective of different stakeholders in a research priority setting of a public health problem in LMIC 

Visit https://capsmg.cochrane.org/ For more details

Participants in Role Play at the Session
Participants in Role Play at the Session
Participants in Role Play at the Session
Participants in Role Play at the Session
Participants in Role Play at the Session
Participants in Role Play at the Session

Notes from the GRADE and SoF #CochraneMethods Workshop at #CochraneHYD

Interpreting results of Cochrane reviews and Summary of Findings Tables: GRADE and SoF Workshop Magnitude of effect and confidence on effect are important parameters in quality of evidence

The Cochrane Colloquium 2014 is keeping up with its trend of providing high quality training for doing systematic reviews. The workshop today focused on the very useful issue of interpreting reviews and summary of findings. The event was done by the McMaster University , Canada faculty.

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Here are some useful notes from the workshop .

Important parameters assessed in GRADE are
risk of bias
inconsistency
indirectness
imprecision
publication bias
dose response ,
size of effect ,
confounding

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The conclusion about the effect of studies should provide the following information.
1.results of section
2.no of studeies
3.magnitude of effect
4.converting it to numbers which stakeholders understand (example : how many fractures were prevented after intervention : use confidence interval to report )
5. GRADE quality of evidence and brief on rational behind it.

New online version of grade software : GDT  www.guidelinedevelopment.org

When using scales and reporting in meta-analysis figure or GRADE table it is always important to communicate direction of scale and what is it about.

Remember to adjust for the image scale in forest plot .

Reviewers often forgot the red, green and yellow dots they have created in the risk of bias during interpretation of results .

Funnel plot cannot be created when less than 10 studies
Consider search strategy comprehensiveness, foreign language missing . smaller studies , grey literature search if funnel plot appears skewed.

Also Look at funding of study and competing interests when looking at publication bias .

Look at the characteristics of study carefully when doing GRADE

Do not use terms like ” not statistically significant” .
It is Important to calculate the optimal information size when using GRADE for imprecision. quality

Imprecision is done on basis of following for dichotomous outcomes : 1. sample size and number of events 2, confidence intervals
Imprecision is done on basis of following for Continuos outcomes : at least 400 people providing outcome measures : if not GRADE for imprecision.

Rule of thumb is if CI includes 0.75 to 1.25 indicates null effect and appreciable benefit or harm

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Distinction between serious and very serious is important : but the balance is to be done by the reviewers: the thinking behind the judgement should be reflected in the footnotes. Let people know the thinking behind the grade done

small sample size but large effect. : could be indicative of the obeservation being just due to chance. Therefore do not depend on confidence interval but on the number of events.

Their are multiple ways of choosing a baseline risk for GRADE process. It can be the average or the extremes or even baseline risk from observational study. However this has to be justified.

All presentations in the colloquium are  available at http://cebgrade.mcmaster.ca/hyderabad/.

From the #CochraneMethods Symposium of the 22nd Cochrane Colloquium, India

The COCHRANE METHODS SYMPOSIUM 2014 held on Sunday 21st September 2014 at Hyderbad, India was themed “” “From concepts to evidence synthesis:Towards a research agenda for methods of public health systematic reviews ”

Here is a list of some key points, quotes and slides I found interesting :

Liz Waters : Question right and match to the right evidence… Focus on evidence landscaping and realistic and narrative (but transparent) synthesis for public health reviews.

Daniel Francis: Logic Models help multi-disciplinary review teams to come together and explain relationships and improve the entire process, identify intervention components , understand rationale behind subgroup analyses and surrogate outcomes- all in a graphical manner.

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James Thomas : Mixed methods meta-analyses allow to empirically understand and explain variations observed- thus allowing contextualization .. Are  complementary to traditional methods.

IMG_0029 IMG_0032

Rebecca Armstrong : Review Advisory groups have an important role and there is need to use them better. Time for Review Advisory Group 2.0 which would include critical friends and stress on web-based technologies and include training as well as link review authors with RAG members .

Ruth Turley : Capturing all relevant evidence with lease amount of noise is difficult in  a public health systematic review. This is complicated by lack of standard terminology, reviews being not restricted to RCT, not indexation of studies and evidence being locked in select databases.

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Jane Noyes : New CERQual tool: will become integrated into the summary of findings tables in Cochrane reviewsIMG_0044IMG_0038 IMG_0040 IMG_0042 IMG_0043 IMG_0045 IMG_0046 IMG_0047

Hilary Thomson: Narrative synthesis of quantitative data the Cinderella of Systematic review

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Elie Akl: The most positive thing about GRADE us that it is systematic transparent and explicit but there are concerns about choice of outcomes and outcome measurements and the fact that the process is solely dependent on epidemiological data and cannot be applied to narrative synthesis and does not discriminated between different types of observational studies.

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The Cochrane Colloquium comes to India

Chowmahalla Palace,Hyderabad
Picture from Chowmahalla Palace,Hyderabad, royal seat of the Asaf Jahi dynasty where the Nizams entertained their official guests and royal visitors.

Cochrane, the global leader in evidence-informed health is for the first time in its more than 20 year history (the first Cochrane Centre opened in Oxford,UK in October 1992 ) is for the first time holding its annual colloquium in India, or for that matter in South Asia.

The 22nd Cochrane Colloquium takes place in Hyderabad, India from 21-26 September, 2014 with the theme ‘Evidence-informed public health: opportunities and challenges’. The event is landmark especially when seen in the background of the impending evidence based medicine as well as universal health coverage in South Asia.The event will see Professor Gordon Guyatt delivering the Annual Cochrane Lecture and plenaries conducted and chaired by global leaders on EBM,public health and policies with the following themes :
1. East meets West: Evidence-Informed Public Health; Concepts, Context, Opportunities, Challenges,
2.Public Health: the context, the vision, the opportunities
3.Capacity Development: Challenges and Innovations
4.Cochrane Reviews: Assuring Quality and Relevance
5.Advocating for Evidence: Improving Health Decision-Making through Advocacy, Partnerships and Better Communication

Five Special themed session which will highlight important issues on the following theme are also scnheduled and their are inumerable workshops held.There are about 88 oral presentations and more than hundred posters.

Keep looking at this page for daily on the spot  updates on the event.
Link: https://colloquium.cochrane.org/