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  • 1. The Cochrane Collaboration www.cochrane.org
  • 2. Introduction to The Cochrane Collaboration  Janet Wale (Cochrane Consumer Network) mission Cochrane reviews and The Cochrane Library structure of the Collaboration  Jordi Pardo Pardo (Iberoamerican Cochrane Centre) diversity  Maryann Napoli (Consumer) efficacy and adverse events in systematic reviews  Jane Cracknell (Review Group Coordinator) editorial base perspective  Andy Oxman (Review Author) types of studies, bias, grading of evidence  Arne Ohlsson (Centre Director) where to from here
  • 3. The Cochrane Collaboration “It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomized controlled trials”. Archie Cochrane, 1979
  • 4. The Cochrane Collaboration The Cochrane Collaboration is an international organization that aims to help people make well-informed decisions about health care by preparing, maintaining, and promoting the accessibility of systematic reviews of the effects of healthcare interventions. ie synthesising healthcare evidence (since 1993)
  • 5. The Cochrane Library Issue 3, 2004 Cochrane Database of Systematic Reviews Full text systematic reviews - ongoing and completed (currently 3,559 reviews and protocols) Database of Abstracts of Reviews of Effects Assessments of reviews (currently 4,795 abstracts of non-Cochrane reviews) Cochrane Central Register of Controlled Trials Bibliographic references of reports of trials (currently 415,918 citations of trials) Cochrane Database of Methodology Reviews Systematic reviews of methodology issues (currently 18 reviews and protocols) The Cochrane Methodology Register References to methodology studies (currently 5,668 theory and methods related citations)
  • 6. The Cochrane Library EFFECT OF LONGER-TERM MODEST SALT REDUCTION ON BLOOD PRESSURE He FJ, MacGregor GA Date of most recent amendment: 04 February 2004 Date of most recent substantive amendment: 06 October 2003 This review should be cited as: He FJ, MacGregor GA. Effect of longer-term modest salt reduction on blood pressure (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd.
  • 7. The Cochrane Collaboration Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis Gillespie WJ, Avenell A, Henry DA, O’Connell DL, Robertson J This Review should be cited as: Gillespie WJ, Avenell A, Henry DA, O’Connell DL, Robertson J. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. The Cochrane Database of Systematic Reviews 2001, Issue 1. This version first published online: 22 January 2001 in Issue 1, 2001. ABSTRACT Background Due to their known effects on bone metabolism, vitamin D and related compounds have been proposed for the prevention of osteoporosis and fractures. Objectives To determine the effects of supplementation with Vitamin D or a Vitamin D analogue in the prevention of fractures of the axial and appendicular skeleton in elderly men or women with involutional or post-menopausal osteoporosis.
  • 8. Cochrane Wounds Group Some review titles • Water for wound cleansing • Therapeutic touch for healing acute wounds • Removal of nail polish and finger rings to prevent surgical infection • Preoperative fasting for adults to prevent perioperative complications • Gauze and tape and transparent polyurethane dressings for central venous catheters • Topical negative pressure for treating chronic wounds • Beds, mattresses and cushions for pressure sore prevention and treatment • Nutritional interventions for preventing and treating pressure ulcers • Therapeutic ultrasound for pressure sores • Compression for venous leg ulcers • Electromagnetic therapy for treating venous leg ulcers • Intermittent pneumatic compression for treating venous leg ulcers • Laser therapy for venous leg ulcers • Oral zinc for arterial and venous leg ulcers • Pentoxifylline for treating venous leg ulcers • Topical agents or dressings for pain in venous leg ulcers • Patient education for preventing diabetic foot ulceration • Pressure relieving interventions for preventing and treating diabetic foot ulcers
  • 9. The Cochrane Collaboration Review Centres Groups Steering Group Methods Fields Groups Consumer Network
  • 10. The Steering Group is supported by the Secretariat Jini Hetherington Claire Allen Nick Royle Deputy Administrator Administrator and Louise Kitchener Chief Executive Company Secretary Administrative Assistant Officer
  • 11. Collaborative Review Groups Review Groups are composed of persons from around the world who share an interest in developing and maintaining systematic reviews relevant to a particular health area.  coordinated by an editorial team who edit and assemble completed reviews into modules for inclusion in The Cochrane Library.
  • 12. Collaborative Review Groups (50) Acute Respiratory Infections Group Airways Injuries Anaesthesia Lung Cancer Back Menstrual Disorders and Subfertility Breast Cancer Metabolic and Endocrine Disorders Colorectal Cancer Methodology Consumers and Communication Movement Disorders Dementia and Cognitive Improvement Multiple Sclerosis Depression, Anxiety and Neurosis Musculoskeletal Developmental, Psychosocial and Learning Musculoskeletal Injuries Problems Neonatal Drugs and Alcohol Neuromuscular Disease Ear, Nose and Throat Disorders Oral Health Effective Practice and Organisation of Care Pain, Palliative and Supportive Care Epilepsy Peripheral Vascular Diseases Eyes and Vision Pregnancy and Childbirth Fertility Regulation Prostatic and Urologic Cancers Gynaecological Cancer Renal Haematological Malignancies Schizophrenia Heart Sexually Transmitted Diseases Hepato-Biliary Skin HIV/AIDS Stroke Hypertension Tobacco Addiction Incontinence Upper Gastrointestinal & Pancreatic Infectious Diseases Diseases Inflammatory Bowel Disease Wounds
  • 13. The Cochrane Collaboration • There should be a clear barrier between the production of Cochrane reviews and any funding from commercial sources with financial interests in the conclusions of Cochrane reviews. • Thus, sponsorship of a Cochrane review by any commercial source or sources (as defined above) is prohibited. Policy on Commercial Sponsorship
  • 14. Fields and Networks (12)  areas of interest which extend across a number of health problems/specific population ensure that their priorities are reflected in the work of existing CRGs compile specialized databases to serve their specific needs Cancer Network Child Health Complementary Medicine Consumer Network Health Care of Older People Health Promotion and Public Health Neurological Network Occupational Health Pre-hospital and Emergency Health Primary Health Care Rehabilitation and Related Therapies Vaccines from: http://www.cochrane.org
  • 15. Methods Groups (10) composed of individuals with an interest and expertise in the science of systematic reviews provide advice and support in the development of the methods of systematic reviews Applicability and Recommendations Campbell-Cochrane Health Economics Health-Related Quality of Life Individual Patient Data Meta-analysis Non-Randomised Studies Prospective Meta-Analysis Qualitative Reporting Bias Screening and Diagnostic Tests Statistical Methods Group from: http://www.cochrane.org
  • 16. What is evidence-based medicine? EBM Clinical Best research expertise evidence Patient values Sackett DL, Strauss SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine. Second Edition 2000 - Churchill Livingstone Slide provided by Bernd Richter
  • 17. The Consumer Network works to ensure that the consumer perspective is incorporated into Cochrane systematic reviews www.cochrane.org/consumers
  • 18. Cochrane Reviews in healthcare decision making “…a good systematic review of whatever evidence is available, even in highly uncertain situations, helps make the policymaking process more transparent and the political or commercial considerations more visible.” Moynihan R. Evaluating Health Services: A Reporter Covers the Science of Research Synthesis, Milbank Memorial Trust 2004;p31. and identifies context, research needs
  • 19. The Cochrane Collaboration The Guiding Principles •Collaboration •Building on enthusiasm of individuals •Avoiding duplication •Minimizing bias •Keeping up to date •Ensuring relevance •Ensuring access •Continuous quality improvement •Continuity •Enabling wide participation
  • 20. The 12th Cochrane Colloqium Ottawa