Who are they?

Archie Cochrane

The Cochrane Collaboration

Formed in 1992• 15,000+ people in 80+ countries• 50 Collaborative Review Groups• 12 Centres, Fields, Method Groups and

Cochrane Consumer Network• Cochrane Secretariat Oxford UK

Cochrane CollaborationCochrane Collaboration

Collaborative Review Groups

Fields

The Consumer Network

Centres

Methods Groups

Steering Group

Represented in 2000, 2002 & 2003

Represented in 2002 & 2003

Represented in 2003

COUNTRIES IN WHICH INDIVIDUALS ARE CONTRIBUTING TOTHE COCHRANE COLLABORATION

Bahrain B

ranch

What do they do?

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

Why do we need The Cochrane Collaboration?

Evidence

Evidence is importantWhy?

• “In 10yrs 50% of what you have been taught will have been shown to be wrong……………..

only problem is which 50%?”

Burwell

Dean of Harvard Medical School 1950

EvidenceEvidence

ClinicalClinicalJudgmentJudgment

Patients ChoicePatients Choice

EBM TRIAD

The Evidence- Based Medicine (EBM) Matrix how findings from research influence clinicians and patient care.

Primary

Research

Synthesis Systematic

Reviews

EBPC

ISDM

Clinical Guidelines/

Guidance

Critical Appraisal

Informed

Patients

Apply Review Quality Improve

How do we do what we do?

Hierarchy of Evidence

• Randomised Controlled Trials

• Non Randomised Controlled studies

• Non Controlled Studies

• Case Studies

Systematic Review & Meta-analysis of RCTs

Randomised controlled Randomised controlled trialtrial

population

group 1

group 2

Outcome

Outcome

intervention

control

RCT

RCT

RCT

RCT

SYSTEMATIC REVIEW

“STRONGER” EVIDENCE

Meta-analysis

What topics do they cover?

• Acute Respiratory Infection

• Airways

• Anaesthesia

• Back

• Breast Cancer

• Colorectal Cancer

• Consumers and Communication

• Cystic Fibrosis and Genetic Disorders

• Dementia and Cognitive Impairment

• Depression, Anxiety and Neurosis

• Developmental, Psychosocial & Learning Problems

• Drugs and Alcohol

• Ear, Nose and Throat Disorders• Effective Practice and Organization of Care• Epilepsy• Eyes and Vision• Fertility Regulation• Gynaecological Cancer• Haematological Malignancy• Heart• Hepato-Biliary• HIV/AIDS• Hypertension• Incontinence

• Infectious Diseases• Inflammatory Bowel Disease• Injuries• Lung Cancer• Menstrual Disorders and Infertility• Metabolic and Endocrine Disorders• Methodology Review Group• Movement Disorders• Multiple Sclerosis• Musculoskeletal• Musculoskeletal Injuries• Neonatal• Neuromuscular Disease

• Oral Health• Pain, Palliative and Supportive Care• Peripheral Vascular Diseases • Pregnancy and Childbirth Group• Prostatic Diseases and Urological Cancers• Renal• Schizophrenia• Sexually Transmitted Diseases• Skin • Stroke • Tobacco Addiction• Upper Gastrointestinal and Pancreatic Diseases• Wounds

Cochrane Fields• Cancer• Child Health• Complementary medicine• Health care of older people• Health promotion and public health• Neurology• Primary Health Care• Rehabilitation and related therapies • Vaccines

Where will you find the evidence?

The Cochrane Library is the single most reliable source for evidence on the effects of health care.

WHAT IS THE COCHRANE LIBRARY

The Cochrane Library is designed to provide information and evidence to support decisions taken in health care and to inform those receiving care.

The Cochrane Library is a collection of 6 main databases and 1 additional database that describes Cochrane as an organization. These are:

1. The Cochrane Database of Systematic Reviews (CDSR)2. The Cochrane Database of Reviews of Effects (DARE)3. The Cochrane Central Register of Controlled Trials (CENTRAL)4. The Cochrane Database of Methodology Reviews (CDMR)5. Health Technology Assessment Database (HTA)6. NHS Economic Evaluation Database (NHS EED)

7. About The Cochrane Collaboration and the Cochrane Collaborative Review Groups

WHAT IS THE COCHRANE LIBRARY?

• More than 2070 Full Reviews

The Cochrane Database of Systematic Reviews (CDSR)

How large is the database?

• 1485 Protocols (Reviews in progress)

Who benefits from The Cochrane Library?

Health professionals at all levels, health researchers, health policy makers, care givers, the pharmaceutical industry, and patients.

How can The Cochrane Collaborationinform healthcare decision

making?

How can The Cochrane Collaborationinfluence healthcare decision

making?

ROFECOXIB FOR RHEUMATOID ARTHRITISGarner S, Fidan D, Frankish R, Judd M, Towheed T, Wells G, Tugwell P

Date of most recent amendment: 10 May 2002Date of most recent substantive amendment: 27 May 2002

• Reviewers' conclusionsIn patients with RA, rofecoxib demonstrates a greater degree of efficacy than placebo, while having a comparable safety profile. Rofecoxib demonstrates a similar degree of efficacy as naproxen, but with a significantly lower rate of ulceration and gastrointestinal bleeding. Rofecoxib was associated with a greater risk for MI, but the exact significance and pathophysiology of this possible relationship is unclear

www.interscience.wiley.com/cochrane

Any Questions?

www.interscience.wiley.com/cochrane

Thank youThank you