An Introduction to Cochrane Collaboration and its Impact on Medical Practices

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1 An Introduction to Cochrane Collaboration and its Impact on Medical Practices Gerd Antes Cochrane Germany ( University Medical Center Freiburg REHA-Kolloquium Frankfurt 20. März 2017

2 Conflicts of interest The Cochrane Germany is a central unit of the University Medical Centre Freiburg G. Antes is 100% employed by the University Hospital Potential conflict: Long-lasting commitment to Evidence and Systematic Reviews

3 Contents Evidence to answer the crucial question: What works? Systematic reviews as key technology for knowledge synthesis Cochrane as host for global knowledge and rigorous methology

4 Knowledge Translaton Transfer of Research into Practice Answers to medical questions Clinical (randomised / controlled) studies Epidemiological (observational -) studies.... Practicing physicians? Health authorities, sickness funds, insurances, institutions Clinical research Patients 50 % Evidencd production 1968 McMaster Univ. Hamilton, Canada 1971 Archie Cochrane, UK 1993 Cochrane Collab Cochrane Germany Evidence application

5 The trial deluge

6 September RCTs (Reports) in Medline Overall:

7 The truth

8 RCTs (Reports) in Medline (PubMed) Overall: September Freiburg Ethics Board : 48% published until 2010 J. Simes (1986)

9 EBM Transfer of Research into Practice Clinical studies (experimental, randomised, controlled, prospective) Epidemiological studies (observational, retrospective) Systematic Reviews Health Technology Clinical Guidelines Patient Information Assessment (HTA) global local Disease Management Programs (DMPs) Clinical Pathways (CPs)

10 The knowledge refinery

11 All trials? identified Not identified? Not published Quality? Review

12 1. Framing the question (PICO) 2. Systematic search for evidence from relevant trials and studies 3. Critical appraisal of trials - inclusion 4. Summary and quantivative synthesis (if possible) 5. Interpreting and putting in context Updating!! July 2011 Produce unbiased view of all evidence

13 Example Thrombolysis after acute myocardial infarction NEJM 1992 Body of Evidence Forest Plot

14 Thrombolysis (Streptokinase) after myocardial infarction NEJM 1992 Forest Plot: Cumulative Forest Plot: Stop - Regel?

15 Open questions No accepted stopping rule Have all relevant trials been identified and considered? Need all (!) relevant trials: 2016 no reliable method and procedure

16 1987 RCTs of aprotinin in cardiac surgery to stop bleeding Lancet 2005 Clinical Trials 2005 Cited 2002

19 Benefit? Harm? Costs?

20 Research in context

22 Leaving things out Selective reporting = 1. Hiding whole trials (classical publication bias) 2. Hiding (or distorting) information from trials which are published 3. Spin: Interpretations which have nothing to do with the trial results

23 Striving for quality: Trial registration as basis for transparency

24 WHO Register Network ICTRP Urology ANZCTR DRKS EU Clinical Trials Register Clinical Trials.gov CT not WHO Primary Registry

25 Declaration of Helsinki 2013 Research Registration and Publication and Dissemination of Results 35.Every research study involving human subjects must be registered in a publicly accessible database before recruitment of the first subject. 36.Researchers, authors, sponsors, editors and publishers all have ethical obligations with regard to the publication and dissemination of the results of research. Researchers have a duty

26 The Cochrane Collaboration (since 1993) Trusted evidence. Informed decisions. Better health Independent network of contributors from science and health professions

27 Systematic Reviews Leading principle: Minimizing bias Risk of Bias

28 The Cochrane Library - free searching and abstracts - updating system Today Cochrane is - a charity under UK law - member of WH assembly - organized globally in entities Cochrane Library Counts September reviews 2516 protocols Impact Factor 2015: (vorläufig)

30 <20% von Cochrane

31 Knowledge accumulation: backfiring?

32 Commentary M. J. Page D. Moher Blog Pubmed Commons Systems of wrong incentives, agendas driven by science and scientists careers, maldevelopment of journals...

33 A new enemy? Open access, data sharing...

34 Old: The poor can t read New: The poor can t write

35 A strong barrier: language

36 1000 lay language summaries in German Most frequently visited SRs

38 The biggest challenge: Updating

39 The solution? Living Systematic Reviews: An Emerging Opportunity to Narrow the Evidence-Practice Gap

41 Summary Systematic reviews as key technology knowledge accumulation to provide evidence for medical decisions Cochrane is an international network to support the production of systematic reviews and to develop rigorous methodology

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NURS 300 BS Nursing Program Orientation Wenli Gao Instructional Services Librarian MSC Butcher Library Contact a librarian Ask at reference desk, 1st floor Chat with us during library hours (Our IM name