The Cochrane Skin Group. Preparing, maintaining, and disseminating systematic reviews of clinical interventions in dermatology

Cochrane Skin Group's Global Social Media Reach: Content Analysis of Facebook, Instagram, and Twitter Posts

BACKGROUND

Researchers in all medical specialties increasingly use social media to educate the public, share new publications with peers, and diversify their audiences.

OBJECTIVE

Given Cochrane Skin Group's expanded use of social media in the past years, we aimed to characterize Cochrane Skin Group's international social media audience and identify themes that result in increased content engagement.

METHODS

Cochrane Skin Group's Facebook, Instagram, and Twitter analytics data were extracted for follower demographics and the most viewed posts within a 3-year span (June 2019 to June 2022).

RESULTS

Overall, Cochrane Skin Group had the highest number of followers on Facebook (n=1037). The number of Instagram and Twitter followers reached 214 and 352, respectively. The greatest numbers of Facebook followers were from Brazil, Egypt, and India, with 271, 299, and 463 followers, respectively. Facebook's most viewed post about Cochrane Skin Group's annual meeting received 1041 views. The top post on Instagram, which introduced Cochrane Skin Group's social media editors, received 2522 views.

CONCLUSIONS

Each of the social media platforms used by Cochrane Skin Group reached varying audiences all over the world. Across social media platforms, posts regarding Cochrane Skin Group meetings, members, and professional opportunities received the most views. Overall, Cochrane Skin Group's multiplatform social media approach will continue to grow an international audience, connecting people interested in skin disease.

The Cochrane Skin Group: Promoting the Best Evidence

Background:

The international Cochrane Skin group, established in 1997, organizes, writes and disseminates systematic reviews of therapeutic interventions in dermatology. ObjectiveTo introduce the Cochrane Skin Group and what it offers to cutaneous medicine and surgery providers.

Methods:

Descriptive review of the structure and output of the Cochrane Collaboration Library and the Cochrane Skin Group.

Results:

Systematic reviews of randomized controlled trials produced through the Cochrane Skin Group provide a benchmark for evidence summaries for informing clinical decisions in dermatology.

Conclusion:

The work performed by the Cochrane Skin Group is an important component for informing the evidence base for the clinical practice of cutaneous and surgical dermatology.

Strengths and limitations of evidence-based dermatology

The need for understanding and reflecting on evidence-based dermatology (EBD) has never been greater given the exponential growth of new external evidence to inform clinical practice. Like any other branch of medicine, dermatologists need to acquire new skills in constructing answerable questions, efficiently searching electronic bibliographic databases, and critically appraising different types of studies. Secondary summaries of evidence in the form of systematic reviews (SR), that is, reviews that are conducted in a systematic, unbiased and explicit manner, reside at the top of the evidence hierarchy, because they are less prone to bias than traditional expert reviews. In addition to providing summaries of the best external evidence, systematic reviews and randomized controlled trials (RCTs) are also powerful ways of identifying research gaps and ultimately setting the agenda of future clinical research in dermatology. But like any paradigm, EBD can have its limitations. Wrong application, misuse and overuse of EBD can have serious consequences. For example, mindless pooling together of data from dissimilar studies in a meta-analysis may render it a form of reductionism that does not make any sense. Similarly, even highly protocolised study designs such as SRs and RCTs are still susceptible to some degree of dishonesty and bias. Over-reliance on randomized controlled trials (RCT) may be inappropriate, as RCTs are not a good source for picking up rare but important adverse effects such as lupus syndrome with minocycline. A common criticism leveled against SRs is that these frequently conclude that there is lack of sufficient evidence to inform current clinical practice, but arguably, such a perception is grounded more on the interpretation of the SRs than anything else. The apparent absence of evidence should not paralyze the dermatologist to adopt a state of therapeutic nihilism. Poor primary data and an SR based on evidence that is not up-to-date are also limitations that can only improve with better primary studies and updated reviews such as those done by the Cochrane Collaboration. Most dermatologists are interested in integrating the best external evidence with the care of individual patients and have been practicing good EBD without realizing it.

The Cochrane Skin Group: a vanguard for developing and promoting evidence-based dermatology

AIM

The Cochrane Skin Group (CSG) is part of the international Cochrane Collaboration (http://www.cochrane.org/). The CSG prepares, maintains and disseminates high quality evidence-based summaries on the prevention, diagnosis and treatment of skin diseases. We present a synopsis of the history, scope and priorities of the CSG. In addition, we report outcomes of CSG reviews and critically assess clinical value.

METHODS

Descriptive analysis of systematic reviews published by the CSG since its inception including output, impact factor, associated methodological studies, and influence in clinical guidelines, promoting patient and public engagement and in triggering new primary research.

RESULTS

The CSG started in 1997, and has published 61 reviews, 34 protocols and 31 registered titles by August 2013. The CSG scope includes 1000 skin diseases; 80% of reviews cover the top ten diagnoses and 40% of reviews provide clear guidance for clinical practice. CSG reviews had an impact factor of 6.1 in 2011 which places it alongside top dermatology journals. CSG reviews are typically broad in focus and have been shown to be of better quality than non-Cochrane reviews. They are highly cited in clinical guidelines. Several reviews have identified evidence gaps that have led to better primary research.

CONCLUSIONS

The CSG has emerged as a vanguard of evidence-based dermatology by growing a community interested in applying best external evidence to the care of skin patients and by identifying topics for research. CSG reviews are high impact, clinically relevant and have tangibly influenced international dermatology clinical practice guidelines and new research.

Usefulness of Cochrane Skin Group reviews for clinical practice

BACKGROUND AND OBJECTIVE

Systematic reviews are one of the most important sources of information for evidence-based medicine. However, there is a general impression that these reviews rarely report results that provide sufficient evidence to change clinical practice. The aim of this study was to determine the percentage of Cochrane Skin Group reviews reporting results with the potential to guide clinical decision-making.

MATERIAL AND METHODS

We performed a bibliometric analysis of all the systematic reviews published by the Cochrane Skin Group up to 16 August, 2012. We retrieved 55 reviews, which were analyzed and graded independently by 2 investigators into 3 categories: 0 (insufficient evidence to support or reject the use of an intervention), 1 (insufficient evidence to support or reject the use of an intervention but sufficient evidence to support recommendations or suggestions), and 2 (sufficient evidence to support or reject the use of an intervention).

RESULTS

Our analysis showed that 25.5% (14/55) of the studies did not provide sufficient evidence to support or reject the use of the interventions studied, 45.5% (25/25) provided sufficient but not strong evidence to support recommendations or suggestions, and 29.1% (16/55) provided strong evidence to support or reject the use of 1 or more of the interventions studied.

CONCLUSIONS

Most of the systematic reviews published by the Cochrane Skin Group provide useful information to improve clinical practice. Clinicians should read these reviews and reconsider their current practice.

Qualitative and quantitative assessment of the benefit-risk ratio of medium potency topical corticosteroids in vitro and in vivo: characterisation of drugs with an increased benefit-risk ratio

Corticosteroids are widely used for the treatment of inflammatory skin disorders. However, systemic and local adverse drug reactions, especially skin atrophy, are potential complications that limit their use. Several attempts have been made to increase the safety of topical corticosteroid treatment, including new application schedules, special vehicles and new agents. In particular, the group of hydrocortisone and prednisolone double esters, with prednicarbate as the first and most often prescribed representative, seem to be equipotent alternatives to the gold standard betamethasone 17-valerate with respect to anti-inflammatory activity. At the same time, these new agents induce less skin atrophy, which may result from a unique skin metabolism and a specific influence on the cytokine network in the epidermis and dermis. On the basis of these effects, a new approach to in vitro quantification of the benefit-risk ratio has been developed. As already suggested by investigations in human volunteers, the benefit-risk ratio of the new compounds appears to be increased. Therefore, recent research has focused on drugs that selectively modulate cytokine release.

Practicing evidence-based dermatology: a short guide

Evidence-based medicine (EBM) is a paradigm for systematically collecting, evaluating, and applying the best information currently available to improve patient outcomes. Effective evidence-based practice requires defining an answerable, well-built question, systematically searching for the best current evidence, and appraising that evidence for validity. Essential components of EBM also require using our clinical expertise to integrate these data with our patients' characteristics, values, and circumstances; archiving the results of our EBM search; and evaluating the efficiency and effectiveness of the EBM process. Incorporating EBM to bring the best current evidence into our field can be mastered with practice and a commitment to apply the process daily.

The Cochrane Skin Group: Promoting the Best Evidence

BACKGROUND

The international Cochrane Skin group, established in 1997, organizes, writes and disseminates systematic reviews of therapeutic interventions in dermatology.

OBJECTIVE

To introduce the Cochrane Skin Group and what it offers to cutaneous medicine and surgery providers.

METHODS

Descriptive review of the structure and output of the Cochrane Collaboration Library and the Cochrane Skin Group.

RESULTS

Systematic reviews of randomized controlled trials produced through the Cochrane Skin Group provide a benchmark for evidence summaries for informing clinical decisions in dermatology.

CONCLUSION

The work performed by the Cochrane Skin Group is an important component for informing the evidence base for the clinical practice of cutaneous and surgical dermatology.

Gesundheitsökonomische Studien in der Dermatologie

Because of reduced resources for health care, provision of modern effective dermatologic care for patients with German public health insurances has become more and more difficult. This survey is designed to aid in the assessment of published health economic studies as well as encourage participation in health economic evaluations. These studies should analyze and optimize the allocation of the available resources. Four main approaches can be used to calculate the incidental expenses; they differ in their methods of evaluation and assessment of health services. They all offer methods to calculate the anticipated costs and consequences. The methods include cost minimization analysis (CMA), cost effectiveness analysis (CEA), cost utility analysis (CUA) or cost benefit analysis (CBA). Many subgroups also exist. Important criteria for the evaluation of health economic trials and hints for the publication of the results are provided on the basis of the recommendations for health economic evaluations.

[Therapy of hand eczema. What can we learn from the published clinical studies?]

Hand eczema is a very common skin disease, which can be induced by different causes. Although many interventions ranging from topical corticosteroids and UV therapy to oral cyclosporine and retinoids are available, the treatment of hand eczema can be very difficult and frustrating. The objective of our study was to assess the external evidence of different treatment modalities for hand eczema. Electronic databases (Cochrane, MEDLINE, Embase, Pascal, Jicst-Eplus, Amed) were systematically searched for clinical trials on therapy for hand eczema. Additionally, four general medical journals (BMJ, JAMA, Lancet, NEJM) and 17 specialists dermatological journals were hand searched from 1977 to August 2004. A total of 100 studies were found and 31 identified as randomised clinical trials (RCTs) dealing with different interventions. Due to the poor quality of most of these RCTs, they are inadequate as a guide to clinical practice. There is a need for high-quality RCTs on therapy for hand eczema regarding established as well as new treatment options taking different subgroups of hand eczema into consideration.

Dermatoepidemiology

Dermatoepidemiology is an important emerging discipline in dermatology. This article reviews clinical and analytic epidemiology pertinent to reading, interpreting, and critically examining the literature, and presents an overview of evidence-based dermatology as a starting point for further study.

Evidenzbasierte Dermatologie und die Cochrane Skin Group

The concept of evidence based medicine (EBM) has represented a paradigm shift in medical thinking and practise in the last decade. However, we seem to be stuck with the phrase, yet it is a term that is frequently abused and misunderstood. Therefore, the purpose of this article is to clarify what evidence based dermatology (EBD) is and what it is not. Some guidance on the four key steps in practising EBM in dermatology will be given. The central role of systematic reviews will be elaborated and the Cochrane skin group introduced. Finally, the limitation of EBD will be discussed.

What is the point of databases of reviews for dermatology if all they compile is “insufficient evidence”?

BACKGROUND

The use of review databases for dermatology has been questioned because of the impression that these reviews frequently report finding insufficient evidence to guide therapeutic recommendations.

OBJECTIVE

We sought to determine the number of review database entries most relevant to dermatology (addressing diseases with skin manifestations whereby a dermatologist may be the primary caregiver) and the percentage of these entries that report sufficient evidence to guide clinical decision making.

METHODS

We conducted computerized searches and analysis of reviews in the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effectiveness. Database entries were categorized using the face value reports of the original reviewers as: (1) finding sufficient evidence to inform clinical decisions; (2) finding insufficient evidence; or (3) unable to classify with regard to degree of evidence found.

RESULTS

Of all review database entries, 3% (54/1235 in Cochrane Database of Systematic Reviews and 65/2208 in the Database of Abstracts of Reviews of Effectiveness) were deemed relevant to dermatology. In all, 14 entries from the Database of Abstracts of Reviews of Effectiveness were in the process of being written and not available for further evaluation. Of the remaining entries, 40% (42/105) reported finding sufficient evidence. Of the 10 most common dermatologic diagnoses, 8 were addressed in 30% (31/105) of these reviews. Of entries addressing common dermatologic diagnoses, 32% (10/31) reported finding sufficient evidence.

CONCLUSIONS

Although few (3%) entries in review databases currently address dermatology topics, entries address many (8/10) of the top 10 dermatology diagnoses. Contrary to popular belief, a substantial number (40%) of such reviews report sufficient evidence to inform clinical decisions making.

Presence of vascular anomalies with congenital hemihypertrophy and Wilms tumor: an evidence-based evaluation

Congenital hemihypertrophy is an uncommon condition of unknown etiology characterized by unilateral overgrowth of part or all of one side of the body. Hemihypertrophy is known to be associated with certain childhood tumors, most notably Wilms tumor (or nephroblastoma), and for this reason infants with hemihypertrophy are often followed with serial abdominal ultrasounds. Klippel-Trénaunay syndrome (KTS) is the triad of port-wine stain, venous varicosities, and soft tissue and/or bony hypertrophy. Children with KTS typically have localized rather than generalized hemihypertrophy, but occasionally the hypertrophy is more extensive than the vascular anomaly itself. Information is lacking about whether hemihypertrophy in this setting can also be a risk factor for Wilms tumor. We systematically reviewed the medical literature to determine whether well-documented cases of Wilms tumor in the setting of both hemihypertrophy and vascular anomalies have been described, and if found, whether the association was sufficiently frequent that routine screening for Wilms tumor in this setting should be recommended. A review of case reports and case series in the pediatric population was undertaken using specific inclusion and exclusion criteria. We found 4 of 58 subjects with hemihypertrophy and Wilms tumor had a reported vascular anomaly, but in only one case was a clear-cut diagnosis of KTS confirmed. The relationship of the other three vascular anomalies reported was of uncertain significance. In conclusion, our review suggests that the risk of Wilms tumor in the setting of localized soft-tissue hypertrophy in conjunction with a vascular malformation is quite low. More extensive hemihypertrophy extending to body sites remote from the vascular malformation itself could have a higher risk of Wilms tumor, although the magnitude of this risk is uncertain. Our findings suggest that routine serial abdominal ultrasounds in patients with vascular malformations in association with localized soft-tissue hypertrophy are unwarranted.