Generating and using evidence to guide public policy and practice: Lessons from the Campbell Test-bed Project

This paper offers lessons from a three-year Test-bed project that tested systematic review practices developed by the Campbell Collaboration and the Cochrane Collaboration. Under the Test-bed project 14 systematic reviews were completed of interventions in crime prevention, social welfare, and education. (References to the products of these test-bed reviews are included in the reference list, preceded by an asterisk). Building on this experience, the authors recommend structuring future reviews around well-defined review topics more explicitly focused on particular interventions, and constraining literature search to evaluations of relevant interventions. Reviewers should analyze and report findings from RCTs separately from non-RCT studies and report on impact estimates in natural units, instead of relying solely on effect size metrics. Further, reviewers should report intent-to-treat estimates as the causally valid outcomes from RCTs. Analyses of impacts for treated sub-groups should be reported as non-experimental findings. More attention should be given to the minimum detectable effect a study can support, as well as any information on the possible costs and benefits of the intervention. Pooling results from studies of disparate interventions, populations, and contexts is not recommended. Meta-analysis should be reserved for homogeneous clusters of interventions studies. Forest plots are helpful for presenting study findings and confidence limits. However, simple bar charts preserve important information on the base levels for the outcomes. Finally reviewers should define a priori the minimum data set or required elements that allow study inclusion, and use this information systematically in making decisions about what evidence to admit into the review.     

Fatal hyperthermia secondary to sunbathing in a patient with multiple sclerosis

A 27-year-old white woman with a history of multiple sclerosis was found dead lying on a lounger, clad in a bathing suit. She had been sunbathing for 4 hours. Significant autopsy findings consisted of numerous variably sized demyelinated plaques involving the periventricular cerebral white matter and cerebellum. Elevation of core temperature in patients with multiple sclerosis leading to transient or permanent adverse neurologic signs and symptoms has been documented for more than 60 years. This case illustrates that a modestly increased core body temperature, even from a usually innocuous activity such as sunbathing, may be fatal in patients with multiple sclerosis.