Volmink Dfidsept2009jvfinal


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  • Getting the evidence straight Getting the evidence used
  • Dependent largely upon volunteer efforts, Cochrane has grown from its original 77 founding individuals led by epidemiologist Iain Chalmers and others to a global network of nearly 12,000 people from more than 90 nations, including over 1,000 individuals from developing countries. The work of these individuals is supported by 84 Cochrane entities, composed of 51 Collaborative Review Groups (CRGs), each responsible for reviews within a particular area of health; 9 Fields with broad areas of interest and expertise spanning the scope of many CRGs; 10 Methods Groups, providing underpinning knowledge and expertise in relevant areas of methodology; a Consumer Network helping to promote the interests and involvement of users of healthcare; and 12 regional Cochrane Centres and their auxiliary branches whose role is to support these Groups. Each of these constituencies is represented on the Collaboration’s elected Steering Group.
  • The regional Cochrane Centres include the Australasian, Brazilian, Canadian, Chinese, Dutch, German, Iberoamerican, Italian, Nordic, South African, UK and US Centres as well as the South Asian and South East Asian Cochrane Networks, branches in Finland, Hong Kong and Russia, and a branch in Bahrain. These centres and Branches in particular as well as individuals in the various other Cochrane entities are active in engaging practitioners, researchers, and policy makers throughout the world in this vital effort to improve global health. While the Cochrane Collaboration Steering Group remains unsatisfied with the overall balance of representation within this international organisation, substantial progress has been made. For instance, the launch of the Bahrain Branch of the UK Cochrane Centre represents a significant step forward that will perhaps one day lead to the establishment of a full Cochrane Centre for Arabic-speaking peoples.   The Cochrane Collaboration is an international not­for­profit organisation registered in the UK as a charity for tax purposes. We exploit the power of the Internet to link our diverse global community of practitioners and researchers into a powerful force for improving healthcare worldwide.
  • Summaries may take different forms synopses, CATS, guideline recommendations. The key is linking summaries tightly to evidence
  • Available cost effective interventions, however still ill health and premature deaths from preventable causes especially developing countries However, despite available evidence, gaps exist between evidence, policy and real world practice. These gaps between what we know and what we do are common and can be explained by various reasons - for example: resource constraints, patient and societal preferences, acceptability and political issues. Identifying gaps not the issue -- Need systematic approaches to address the gap – to promote the use of best evidence and strategic research Millendium development goals – 2015, 8 goals, 18 targets, 348 indicators
  • Volmink Dfidsept2009jvfinal

    1. 1. Promoting Evidence-based Health Care: the role of the Cochrane Collaboration? Jimmy Volmink Faculty of Health Sciences, Stellenbosch University SA Cochrane Centre, Medical Research Council
    2. 2. Outline <ul><li>What is evidence-based health care? </li></ul><ul><li>What is the Cochrane Collaboration and what does it do? </li></ul><ul><li>How does the Collaboration get its message over to information users? </li></ul>
    3. 3. What is evidence-based health care? “ the conscientious, explicit and judicious use of the current best evidence in making (health care) decisions.” Sackett DL, et al. 1997 “ The notion that right-minded people will naturally make decisions on the basis of the best available scientific evidence is a misleading and dangerous idea.” Erve Chambers, 1985
    4. 4. “ Know-do gap” Evidence Practice
    5. 5. EBHC: The case for systematic reviews <ul><li>Information overload is a barrier to research utilization </li></ul><ul><li>Poor quality of reviews of the medical literature </li></ul><ul><li>Problem characterized as a “double-standard” with potentially dire consequences for patients and other consumers of health care </li></ul><ul><ul><li>“ advice on some life-saving therapies has been delayed for more than a decade , while other treatments have been recommended long after controlled research has shown them to be harmful.” </li></ul></ul><ul><ul><li>Antman et al. JAMA 1992; 268: 240-8 </li></ul></ul>
    6. 6. A systematic review defined as…. <ul><li>“ A review in which bias has been reduced by the systematic identification, appraisal, synthesis, and, if relevant statistical aggregation of all relevant studies on a specific topic. according to a predetermined and explicit method ” </li></ul><ul><li>Moher et.al. Lancet 1999 </li></ul>
    7. 7. Steps involved in conducting a systematic review <ul><li>S tat e the objectives of the review </li></ul><ul><li>D efin e eligibility criteria for studies to be included </li></ul><ul><li>I dentify (all) potentially eligible studies </li></ul><ul><li>A pply eligibility criteria </li></ul><ul><li>Assess study quality </li></ul><ul><li>A ssembl e the most complete dataset feasible </li></ul><ul><li>A nalys e this dataset, using statistical synthesis and sensitivity analyses, if appropriate and possible </li></ul><ul><li>P repar e a structured report of the research </li></ul>
    8. 8. Benefits of systematic reviews <ul><li>Reduce large quantities of information to useful form </li></ul><ul><li>Provide reliable information </li></ul><ul><li>Increased power and precision </li></ul><ul><li>Investigate conflicting findings </li></ul><ul><li>Establish generalizability of findings </li></ul><ul><li>Shorten time from discovery to implementation </li></ul>
    9. 9. The Cochrane Collaboration is an international organisation that aims to help people make well-informed decisions about healthcare by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions
    10. 10. Cochrane Collaboration <ul><li>Established in 1993 now has: </li></ul><ul><li>15,000 contributors </li></ul><ul><li>from more than 100 countries </li></ul><ul><li>over 1,000 individuals from developing countries </li></ul><ul><li>13 Centres with associated networks </li></ul><ul><li>51 Cochrane Review Groups </li></ul>
    11. 11. Canadian US UK Nordic Dutch German Italian IberoAmerican Chinese Australasian South African Brazilian Bahrain Branch Thai Network South Asian Centre and Network New Zealand Branch ch San-Francisco Branch Cochrane Centres and Branches Hong-Kong Russian Branch Japanese Branch Nigerian Branch
    12. 13. SACC: Main focus areas <ul><li>Reviews relating to the MDGs </li></ul><ul><ul><li>HIV, TB, malaria </li></ul></ul><ul><ul><li>MCH </li></ul></ul><ul><ul><li>Nutrition </li></ul></ul><ul><ul><li>Health systems </li></ul></ul><ul><li>Promoting EBHC </li></ul><ul><li>Developing the science of research synthesis </li></ul>
    13. 14. SACC key collaborators <ul><li>Liverpool School of Tropical Medicine </li></ul><ul><li>UK Cochrane Centre </li></ul><ul><li>Norwegian Knowledge Centre for the Health Services </li></ul><ul><li>Institute of Global Health at the University of San Francisco </li></ul><ul><li>University of Calabar </li></ul><ul><li>University of Nairobi </li></ul>
    14. 15. African Cochrane contributors meeting 2007
    15. 16. Current developments <ul><li>SU Food Security initiative </li></ul><ul><li>Collaboration with Nutrition Information Centre of University of Stellenbosch (NICUS) </li></ul><ul><li>Centre for Evidence-based Nutrition </li></ul>
    16. 17.   IMPACT FACTOR OF 5.2 in 2009 Ranked 12th out of 107 in the ISI category Medicine, General & Internal.  /
    17. 18. 3916 complete reviews 1905 reviews in progress (protocols) 586,829 clinical trials Cochrane Library Issue 3, 2009
    18. 19. Full text downloads of Cochrane reviews in SA
    19. 20. India obtains national subscription to the Cochrane Library in 2007. Full text downloads of Cochrane reviews in India reaches 66,303 in 2008
    20. 21. Towards ‘actionable messages’ Studies (primary research) Systematic Reviews Summaries
    21. 22. PloS Medicine, 2005 <ul><li>Tsunami 26 December 2004 </li></ul><ul><li>“ the greatest natural disaster in living memory” </li></ul><ul><ul><li>killed >280,000 people </li></ul></ul><ul><ul><li>displaced > 1million </li></ul></ul><ul><ul><li>affected the lives of five million more </li></ul></ul><ul><li>Evidence Aid launched to ensure that most reliable and relevant information available to enable survivors to receive the best care </li></ul>
    22. 23. Brief ‘debriefing’ for trauma <ul><li>Indian National Institute of Mental Health and Neurological Sciences strongly promoted mass single session de-briefing for people in tsunami affected villages </li></ul><ul><ul><li>to reduce immediate psychological distress </li></ul></ul><ul><ul><li>to prevent the subsequent development of psychological disorders, in particular PTSD </li></ul></ul><ul><li>Cochrane review identified that concluded, contrary to popular belief, that single session debriefing was unlikely to be helpful and possibly harmful (increase in PTSD) </li></ul><ul><li>Message incorporated into the content of counsellor training workshops </li></ul><ul><li>. </li></ul>
    23. 26.
    24. 27. SUPPORT summaries
    25. 28. STEPP Project <ul><li>Joint effort of SACC and PGWC </li></ul>Available knowledge Application in policy and practice
    26. 29. <ul><li>300 page, peer reviewed report </li></ul><ul><li>3 main sections </li></ul><ul><ul><li>Physiology and pathophysiology of nutrition, immunity and infection </li></ul></ul><ul><ul><li>Clinical evidence of effects </li></ul></ul><ul><ul><li>Conclusions and recommendations </li></ul></ul><ul><li>Released August 2007 in full and condensed versions; press/media launch; govt.departments; dissemination of 3000 copies </li></ul>
    27. 31. Male circumcision for prevention of heterosexual acquisition of HIV in men <ul><li>Intense interest in results of review – covered in: </li></ul><ul><li>Print media – 90 articles in 20 countries </li></ul><ul><li>SA radio – 6 stations </li></ul><ul><li>TV - SABC 2 and SABC 2 international </li></ul>
    28. 32. Evidence in Action Game
    29. 33. Summary of evolving Cochrane communication strategy <ul><li>1. Disseminate tailored research syntheses (“push”) </li></ul><ul><li>- increase awareness of research synthesis among policy makers, providers and researchers; tailor materials to specific audiences and needs. </li></ul><ul><li>2. Increase dialogue (“exchange”) </li></ul><ul><li>- seek dialogue with policy makers e.g. WHO, governments, etc. around the use of reviews </li></ul><ul><li>3. Increase demand for evidence (“pull”) </li></ul><ul><li>- create and increase demand for evidence from different target groups and ensure evidence-informed thinking and decision making is embedded in national and regional health structures </li></ul>