Cochrane Collaboration

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Cochrane Collaboration

• A no-profit 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 health care interventions.

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Archie Cochrane
It is surely a great criticism of our
profession that we have not organised a critical
summary, by specialty or subspecialty, adapted
periodically, of all relevant randomised
controlled trials.
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THE COCHRANE COLLABORATIONlthttp//www.cochrane.or
ggt
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Principles

• Collaboration
• Building on the enthusiasm of individuals
• Avoiding duplication
• Minimising bias
• Keeping up to date
• Striving for relevance
• Ensuring quality

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Systematic review
Systematic review
Systematic review

• Structured process involving several steps
• Well formulated question
• Comprehensive data search
• Unbiased selection and abstraction process
• Critical appraisal of data
• Synthesis of data

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Cochrane Collaboration
Collaborative Review Groups
Centres
Steering Group
Methods Groups
Fields
The Consumer Network
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Cochrane Collaboration
Collaborative Review Groups
Centres
Steering Group
Methods Groups
Fields
The Consumer Network
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Cochrane Centres
Canadian
Nordic
San Francisco
German
UK
Dutch
French
Iberoamerican
Italian
San Antonio
Chinese
New England
Brazilian
South African
Australasian
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Cochrane Centres

• Help organise and register review groups
• Facilitate collaboration among reviewers
• Provide training and consultation
• Establish liaisons
• Promote the Cochrane Collaboration
• Provide unique contribution

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Cochrane Collaboration
Collaborative Review Groups
Centres
Steering Group
Methods Groups
Fields
The Consumer Network
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Review Groups 48 registered, 1 possible

• Acute respiratory infections
• Airways
• Anaesthesia
• Back
• Breast cancer
• Colorectal cancer
• Consumers and communication
• Cystic fibrosis and genetic disorders
• Dementia cognitive improvement
• Depression, anxiety neurosis

• Developmental, psychosocial and learning problems
• Drugs and alcohol
• Ear, nose and throat disorders
• Effective practice and organisation of care
• Epilepsy
• Eyes and vision
• Fertility regulation
• Gynaecological cancer
• Heart
• Hepato-biliary

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Review Groups

• HIV/AIDS
• Hypertension
• Incontinence
• Infectious diseases
• Inflammatory bowel disease
• Injuries
• Lung cancer
• Menstrual disorders and subfertility
• Metabolic and endocrine disorders
• Movement disorders
• Multiple sclerosis

• Muskuloskeletal
• Musculoskeletal injuries
• Neonatal
• Neuromuscular disease
• Oral health
• Pain, palliative and supportive care
• Peripheral vascular diseases
• Pregnancy and childbirth
• Prostatic diseases and urologic cancers
• Renal
• Schizophrenia

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Review Groups

• Sexually transmitted diseases
• Skin
• Stroke
• Tobacco addiction
• Upper gastrointestinal and pancreatic diseases
• Wounds
• Haematological malignancies (possible)

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Review Group products

• Reviews
• Specialised register

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Review Groups

• Reviewers
• International group
• Review relevant trials on specified health care
  problems
• Long-term commitment

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Collaborative Review Group process
Systematic Reviewer
Systematic Reviewer
Systematic Reviewer
Editors
Review Group Co-ordinator
Systematic Reviewer
Systematic Reviewer
Cochrane Database of Systematic Reviews
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Review Manager (RevMan)

• Cochrane Collaboration software for
• Preparing and maintaining protocols and reviews
• Data analysis
• Submitting completed reviews to Cochrane
• database

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RevMan statistical options

• Peto Method
• Odds Ratio
• Mantel-Haenszel fixed effect and
  Dersimonian/Laird random effects
• Odds Ratio, Relative Risk, Risk Difference
• Weighted and Standardised Mean Differences

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The Cochrane Library

• The Cochrane Database of Systematic Reviews
  (CDSR)
• The Database of Abstracts of Reviews of
  Effectiveness (DARE)
• The Cochrane Controlled Trials Register (CCTR)
• The Cochrane Methodology Register

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Cochrane Collaboration
Collaborative Review Groups
Centres
Steering Group
Methods Groups
Fields
The Consumer Network
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Fields9 registered, 1 possible

• Represent a population, group, or type of care
  that overlaps multiple Review Group areas
• Examples Primary Health Care, Health Care of
  Older Adults, Complementary Medicine, Vaccines,
  Rehabilitation and Related Therapies

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Methods Groups11 registered, 5 possible

• Develop methods and products integral to internal
  functioning of the Collaboration
• Develop state of the art methods for systematic
  reviews
• Examples Statistical Methods, Economics, Placebo
  Effects, Informatics

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The Consumer Network

• Provides consumer input
• Helps set priorities
• Helps with dissemination

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Cochrane Collaboration
Collaborative Review Groups
Centres
Steering Group
Methods Groups
Fields
The Consumer Network
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Summary of The Cochrane Collaboration

• International collaboration
• Prepares, maintains, and disseminates systematic
  reviews
• Diverse internal structure (Review Groups,
  Centres, Fields, Methods Groups, the Consumer
  Network)

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Identifying Trials

• Computerised searches CCTR ,MEDLINE, EMBASE
• Hand searches
• Meeting abstracts
• Trial registers
• Pharmaceutical companies
• Word of mouth / Questionnaire

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• Considerable evidence that positive trials are
  more likely to be published than negative
  trials
• Simple electronic literature search is likely to
  result in a sample of trials biased towards the
  positive

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Identification of TrialsMeta-analysis of
neoadjuvant chemotherapy for cervix cancer
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Publication Status of Eligible
TrialsMeta-analysis of neoadjuvant chemotherapy
for cervix cancer
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The Use of Individual Patient Data (IPD) in
Systematic Reviews

• Lesley, Stewart1, Mike Clarke2, Jayne Tierney1
• (Cochrane MWG on IPD meta-analyses)
• 1MRC Clinical Trials Unit, Cancer
  Division,Cambridge
• 2Clinical Trial Service Unit, Oxford
• Statistics in Medicine 1995 14 2057-2079

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What is an IPD Meta-analysis?

• Involves the central collection, checking and
  analysis of updated individual patient data
• Include all properly randomised trials, published
  and unpublished
• Include all patients in an intention-to-treat
  analysis

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THE COCHRANE COLLABORATIONlthttp//www.cochrane.or
ggt