Systematic reviews and randomised trials: influencing public policy
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This document discusses the role of systematic reviews and randomized trials in influencing public policy and healthcare decisions. It provides examples of trials such as ISAT on aneurysm treatment and MidU on midwifery-led vs consultant-led care that directly impacted clinical guidelines. The document emphasizes that reliable evidence from systematic reviews is needed to minimize bias and maximize previous research. Resources like the Cochrane Library and Collaboration aim to disseminate this evidence to improve healthcare and health outcomes.
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Systematic reviews and randomised trials: influencing public policy
- 1. Systematic reviews and randomised trials: influencing public policy 2 April 2008 Professor Mike Clarke UK Cochrane Centre Clinical Trial Service Unit, University of Oxford School of Nursing and Midwifery, Trinity College Dublin
- 5. Example
- 7. International Sub-arachnoid haemorrhage trial ISAT
- 13. Death
- 16. Treatments for stroke: from suggestion through randomised trials to routine clinical practice 1920 1930 1940 1950 1960 1970 1980 1990 2000 Coiling ruptured aneurysms Cholesterol - 2 0 prevention BP - acute stroke BP - 2 0 prevention Thrombolysis - acute stroke Warfarin in SR - 2 0 prevention Warfarin in AF - 2 0 prevention Heparin - acute stroke Neuroprotection - acute stroke Aspirin - acute stroke Thienopyridines - 2 0 prevention Dipyridamole + asp - 2 0 prevention Aspirin - 2 0 prevention Carotid angioplasty Carotid endarterectomy
- 17. Example
- 19. MidU Study
- 31. Overwhelming amount of healthcare literature
- 33. health
- 36. Example
- 39. Tamoxifen vs no tamoxifen, 1998
- 40. Avoiding undue emphasis on individual trials
- 41. How sure are we about this treatment?
- 42. How sure are we about this treatment?
- 43. Tamoxifen for 5 years (ER+), 2005 Breast cancer death Recurrence
- 48. What resources are available to help?
- 54. Implications for Practice (2006) 84 (3%) Only use in research 1409 (50%) Uncertain 206 (7%) Intervention doesn’t work 1305 (47%) Intervention works 2801 All Cochrane reviews
- 55. Implications for Research (2005) 82 (3%) No more research 1315 (52%) Types of outcome 765 (30%) Types of participant 2079 (82%) Types of intervention 2535 All Cochrane reviews