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The article in last month’s issue explored the place of systematic reviews in informing health care decision making. This article describes the core components of a high-quality systematic review of health care interventions. These components include an assessment of the risk of bias for individual studies, evaluation of the overall certainty of the body of evidence for the main outcomes, meta-analysis and the interpretation of the data. An understanding of these differing elements is the key to recognising the potential and important limitations of any systematic review.

This article explores how systematic reviews can provide a useful addition to a general practitioner’s knowledge toolbox and explores scenarios where systematic reviews can be used to help inform a decision. The article also explores how the trustworthiness of the information from a systematic review or indeed any knowledge resource, can be assessed, and describes some of the ways that systematic reviews are changing. A follow up article will explore, in more detail, how to appraise, understand and use the information in a systematic review.

Objective.Although protocol registration for systematic reviews is still not mandatory, reviewers should be strongly encouraged to register the protocol to identify the methodological approach, including all outcomes of interest. This will minimize the likelihood of biased decisions in reviews, such as selective outcome reporting. A group of international experts convened to address issues regarding the need to develop hierarchical lists of outcome measurement instruments for a particular outcome for metaanalyses.Methods.Multiple outcome measurement instruments exist to measure the same outcome. Metaanalysis of knee osteoarthritis (OA) trials, and the assessment of pain as an outcome, was used as an exemplar to assess how Outcome Measures in Rheumatology (OMERACT), the Cochrane Collaboration, and other international initiatives might contribute in this area. The meeting began with formal presentations of background topics, empirical evidence from the literature, and a brief introduction to 2 existing hierarchical lists of pain outcome measurement instruments recommended for metaanalyses of knee OA trials.Results.After discussions, most participants agreed that there is a need to develop a methodology for generation of hierarchical lists of outcome measurement instruments to guide metaanalyses. Tools that could be used to steer development of such a prioritized list are the COSMIN checklist (COnsensus-based Standards for the selection of health status Measurement Instruments) and the OMERACT Filter 2.0.Conclusion.We list meta-epidemiological research agenda items that address the frequency of reported outcomes in trials, as well as methodologies to assess the best measurement properties (i.e., truth, discrimination, and feasibility).

This article describes the background and contribution of The Cochrane Collaboration to the WHO Nutrition Guidelines program. Systematic reviews, augmented by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology for assessing the quality of a body of evidence, form the evidence basis for WHO guidelines. Our shared experience of working together has highlighted a number of issues that are challenging, such as decisions made about selecting appropriate questions for evidence synthesis and the nature of study types that are included, in particular the decision on whether or not to extend a search beyond randomized studies. Although the skills and experience required for evidence synthesis are different from those needed to determine recommendations for policy and practice, our experience suggests that some engagement between the two groups is mutually beneficial. Finally, our experience highlights the recognition that evidence of effectiveness is essential but by no means sufficient to guide decisions on recommendations. Programmatic and implementation considerations are important to guide decision making and the evidence basis for this may be limited; therefore, it is essential that groups involved in delivering interventions to populations are also engaged in the guidelines process.

Prior to the Outcome Measures in Rheumatology (OMERACT) 12 meeting in Budapest, Hungary, a workshop was held bringing together individuals from a number of international outcome measure organizations to assess how best to further develop consensus on how pain is conceptualized and measured in trials of musculoskeletal conditions, and how the trials should be reported in systematic reviews.

The WHO evidence-informed guidelines provide recommendations to Member States and their partners on interventions with vitamins and minerals. Evidence gathered and synthesized through systematic reviews contributes to the development of these guidelines, a process that is dependent on the availability and quality of evidence. Although the guideline development process is stringently governed and supervised to maintain clarity and transparency, the lack of adequacy and specificity of available evidence poses limitations to the formulation of recommendations that can be easily applied for policy and program decision making in diverse contexts. The symposium created a space for dialogue among scientists and public health practitioners to improve the understanding of how evidence fulfills the needs and reflect on mechanisms by which policy and program guidance and priorities for research could be better informed by policy and program needs. Ultimately, programmatic success depends not only on identifying efficacious agents but ensuring effective delivery to those with the potential to respond. To do this, we must understand the rationale for recommending interventions, the biological pathways by which interventions work, delivery systems required to make efficacious interventions work, and other contextual factors that might limit or facilitate successful implementation.

The article describes the partnership between the Ohio Choral Directors Association (OCDA) and the Ohio Music Education Association (OMEA). Among the collaborative efforts of OCDA and OMEA are the selection of choral clinicians for OMEA winter conference and the administration of multicultural awareness programs and standards. OCDA activities are also discussed, including a workshop on South African choral traditions at Kenyon College and the OCDA summer conference at Otterbein University in Ohio.

The article looks at the teaching of multicultural music education in Ohio due to emerging numbers of children in schools in Ohio with different ethnicity including African Americans, Latin Americans, and Asian Americans. By the year 2000, most music education training programs included a course requirement in world music. The publications of World Music Press provided music instructors from North America with collections of original musical pieces from non-Western cultures, and includes the performance by the master performers within those cultures.

The article provides information on the Ohio Music Education Association (OMEA) Gospel Choir Project which emphasizes the state's cultural and ethnic diversity. The project, proposed by the Multicultural Committee of OMEA and approved by the State Board, involved the formation and performance of a gospel choir in conference Ohio cities including Cincinnati, Cleveland, and Columbus. The objective is to establish a high school gospel choir for OMEA conferences and to strengthen the organization's musical, cultural and educational aspects.