Who are they?

Archie Cochrane

The Cochrane Collaboration Formed in ,000+ people in 80+ countries 50 Collaborative Review Groups 12 Centres, Fields, Method Groups and Cochrane Consumer Network Cochrane Secretariat Oxford UK

Cochrane 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 TO THE COCHRANE COLLABORATION Bahrain Branch

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 important Why? “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

Evidence Clinical ClinicalJudgment Patients Choice EBM TRIAD

The Evidence- Based Medicine (EBM) Matrix how findings from research influence clinicians and patient care. Primary Research SynthesisSystematic Reviews EBPC ISDM Clinical Guidelines/ Guidance Critical Appraisal Informed Patients ApplyReview 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 trial population group 1 group 2 Outcome intervention control

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 Collaboration inform healthcare decision making?

How can The Cochrane Collaboration influence healthcare decision making?

ROFECOXIB FOR RHEUMATOID ARTHRITIS Garner S, Fidan D, Frankish R, Judd M, Towheed T, Wells G, Tugwell P Date of most recent amendment: 10 May 2002 Date of most recent substantive amendment: 27 May 2002 Reviewers' conclusions In 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

Any Questions?

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