Transcript Slide 1

Systematic Reviews,
The Cochrane Collaboration
Michele L. Hales
University of Alberta
Edmonton, AB CANADA
October 2nd & 3rd, 2003
Dubai, U.A.E.
The Cochrane Collaboration
"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".
-- Archie Cochrane, 1979
The Collaboration is being built on a
set of eight values:
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Collaboration
Building on the enthusiasm of individuals
Avoiding duplication
Minimizing bias
Keeping up to date
Ensuring relevance
Ensuring access
Continually improving the quality of work
M. Haugh and D. Fouque. Evidence-based nephrology. Nephrol Dial
Transplant (1999) 14 [Suppl 3]: 38-41
The Cochrane Collaboration is an international
network of health care professionals, researchers
and consumers who are interested in developing
and maintaining comprehensive, regularly
updated critical reviews of evidence from
randomised clinical trials relevant to their
specialty and interests.
Brief History
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The first systematic reviews were in the field of
Pregnancy and Childbirth.
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Increased interest from professional groups,
health managers, and government organisations
in extending the scope of systematic reviews.
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The Cochrane Database of Systematic Reviews is now
published quarterly in the electronic journal The
Cochrane Library.
Cochrane Centres
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Cochrane Centres have been established in a
number of countries world-wide, funded by
both government and charitable sources.
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Responsible for maintaining registers of known
randomised controlled trials, complete
systematic reviews as well as current and
potential contributors to the Collaboration.
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Provide advice and training to those who
contribute to the Collaboration .
The Cochrane Renal Group (CRG)
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The Cochrane Renal Group (CRG) began
March 1, 1997.
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The Cochrane Renal Group (CRG) is one of 50
Cochrane Collaboration review groups around
the world and consists of individuals who share
a common interest in renal disease. Members of
the group include reviewers, handsearchers,
referees, consumers, government as well as the
editorial team.
What is a systematic review?
A reviewer must:
1. identify an intervention for a specific disease, and ask
whether or not this intervention works.
It’s accomplished by:
1. locating, reviewing and assessing evidence from as
many relevant scientific studies as possible.
2. summarising the conclusion with respect to its
effectiveness
3. providing the summary as a unique collation of the
known evidence on a given topic.
At this point, the primary studies for any intervention are
made available for others to review.
Validity Guide of the SR
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Is this a systematic review of randomised
trials?
Does this systematic review have a “methods”
section that describes:
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Finding and including all relevant trials
How the validity of the individual studies was
assessed?
Were the results consistent from study to
study?
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Importance of SR Validity
Results
What is the magitude of the treatment effect?
How precise is the treatment effect?
Are the valid results of this SR applicable
to our Patient?
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Is our patient so different from those in the study that its
results?
How precise is the treatment effect?
What are our patient’s potential benefits and harms from the
therapy?
What are our patient’s values and preferences for both the
outcome we are trying to prevent and the side-effects we may
cause?
Renal Reviews
Responsibilities include:
Identify all trials concerning renal diseases
 Assess the trials for relevance and quality
 Assemble and analyse the trial data
 Prepare structured reports for inclusion in the
Cochrane Database of Systematic Reviews
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CRG’s Focus
The Cochrane Renal Group's focus includes the following
major areas of renal disease:
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Acute renal failure
Chronic renal failure
Dialysis: both peritoneal and haemodialysis
Renal transplantation
Renovascular hypertension
Glomerular diseases
Urinary tract infections
Nephrolithiasis
Areas of High Priority
Renal Transplantation
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Tacrolimus for renal transplant recipients
Antilymphocyte preparations for renal transplant recipients
IL-21 receptor blockers for renal transplant recipients
Sirolimus for renal transplant recipients
Dialysis
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Interventions to prevent peritonitis & exit site infections in peritoneal
dialysis
Treatment for dialysis-related hypotension
General Nephrology
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Corticosteroids for minimal change nephropathy in adults
Interventions to prevent contrast-induced nephropathy
Interventions to reduce infection risk in nephrotic syndrome
Interventions to reduce thrombosis risk in nephrotic syndrome
Trials in Nephrology
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Published Trials (4100)
Ongoing Trials (57)
Current Trials
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Acute Renal Failure (1)
Diabetic Nephropathy (4)
Dialysis (17)
General Nephrology (14)
Transplantation (17)
Urinary Tract Infection (3)
Current Trials
Acute Renal Failure (1)
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Effects of different doses in continuous veno-venous
haemofiltration on outcomes of acute renal failure: a
prospective randomised trial.
Diabetic Nephropathy (4)
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Dual blockade of the renin-angiotensin system in type 1
patients with diabetic nephropathy
Effect of dietary protein restriction on prognosis in
patients with diabetic nephropathy
The role of angiotensin II receptor blockers in preventing
the progression of renal disease in patients with type 2
diabetes.
Dual blockade of the renin-angiotensin system versus
maximal recommended dose of ACE inhibition in diabetic
nephropathy.
Current Trials Cont’d
Dialysis (17)
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Transferrin saturation versus reticulocyte hemoglobin
content for iron deficiency in Japanese hemodialysis patients.
Creatine monohydrate treatment alleviates muscle cramps
associated with haemodialysis.
Effect of dialysis dose and membrane flux in maintenance
hemodialysis.
A controlled, prospective study of the effects of atorvastatin
on proteinuria and progression of kidney disease.
Effects of long and short hemodialysis on endothelial
function: A short-term study.
Effects of raloxifene on bone metabolism and serum lipids
in postmenopausal women on chronic hemodialysis.
Current Trials Cont’d
General Nephrology (14)
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Reduction of proteinuria; combined effects of receptor
blockade and low dose angiotensin-converting enzyme
inhibition. [see comments.]
Renoprotective effect of small doses of losartan and enalapril
in patients with primary glomerulonephritis. Short-term
observation.
Effects of combined ACE inhibitor and angiotensin II
antagonist treatment in human chronic nephropathies.
Carvedilol increases two-year survival in dialysis patients with
dilated cardiomyopathy: a prospective, placebo-controlled
trial.
Antihypertensive treatment with and without benazepril in
patients with chronic renal insufficiency: a US economic
evaluation.
The Cochrane Library
It is a one of a kind source of reliable, up to date
information on the effects of interventions in health care.
Today’s healthcare needs to include the best information
on the effectiveness of each intervention being accessible
to practitioners, patients, and policy makers. This is
“evidence-based medicine.”
The library is designed to provide information and
evidence to support decisions taken in health care and to
inform those receiving care.
Cochrane Library
The Library includes:
Full text, including graphs, of the original systematic
review
 Quality assessed information
 Critical appraisals of high-quality reviews published
elsewhere
 A number of very useful accompanying databases
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Searches – Library Database
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Search by specific topic
Combine words or phrases to modify the
meaning of a search
Searches can be refined by selecting date ranges,
document status, or by titles or authors only
The history screen grabs each search for future
retrieval or to combine with new search terms
MeSH Thesaurus
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The library provides a MeSH search facility as an
added search aid
The MeSH thesaurus is published by the NLM
Has a vocabulary of 15,000 terms for precise
description of the medical documents content
Terms are arranged as a ‘tree structure’ which
links related terms.
Terms can be further defined by the addition of
qualifiers
The Renal Health Library
It contains:
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relevant systematic reviews on kidney disease from the
Cochrane Database of Systematic Reviews
references to over 4000 randomised controlled trials in
kidney disease from the Cochrane Renal Group's Renal
Trials Register, including 650 abstracts from conference
proceedings
over 50 reports of ongoing randomised controlled trials
information about the Cochrane Collaboration, the
Cochrane Renal Group and the systematic review
process
Renal Health Library CD
May 2003 (1st Issue)
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Contains over 4000 randomised controlled trials,
including ongoing trials, with links to abstracts on
PubMed and 36 full-text reviews in nephrology.
Contact Information
Cochrane Renal Group
Centre for Kidney Research
The Children’s Hospital at Westmead
NSW 2045 Australia
tel: +61 2 9845 1292
fax: +61 2 9845 3038
e-mail: [email protected]
website: www.cochrane-renal.org