Cochrane systematic reviews as a source of information for practice and trials
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ORAL PRESENTATION Open Access Cochrane systematic reviews as a source of information for practice and trials Mike Clarke 1* , Thomas T Clarke 2 , Lorcan Clarke 2 From Clinical Trials Methodology Conference 2011 Bristol, UK. 4-5 October 2011 Background Systematic reviews should be used to provide the ethical, scientific and environmental justification for a new ran- domised trial [1]. The Cochrane Collaboration is the world’ s largest organisation dedicated to preparing and maintaining systematic reviews of the effects of health- care interventions [2]. These are published in the Cochrane Database of Systematic Reviews (CDSR) and all Cochrane Reviews have a rigid structure, which includes the authors’ conclusions on the implications for practice. Therefore, this collection of reviews provides a readily available source of information on the evidence base for the use of a large number of interventions in health care. Objectives We assessed all new and updated reviews in the first twelve monthly issues of CDSR from February 2010 to January 2011 to identify their relevance to the evidence base for current practice and for future trials to resolve continuing uncertainties. Methods At least two authors independently examined the impli- cations for practice in the authors’ conclusions of each new and updated review in issues 2-12 2010 and issue 1 2011 of CDSR. Each review was coded to indicate whether its authors concluded that a specific interven- tion should only be used in research, was not supported or refuted by the evidence in the review, had been shown to be effective, or should not be used in practice (or could not be recommended). Each review was also coded by area of health or health care. The final deci- sions on coding were taken by one author. Results These 12 monthly issues of CDSR contained 390 new and 462 updated reviews, many of which provide evi- dence on more than one intervention. The authors of 25 (2.9%) of these reviews concluded that an interven- tion should only be used in research and 494 (58.0%) concluded that the evidence for an intervention was insufficient to support or refute its use. At least one intervention in 413 (48.5%) of these reviews was judged to be effective by the review authors and the authors concluded that an intervention should not be used or could not be recommended in 139 (16.3%) reviews. Conclusions Cochrane Reviews identify many interventions for which the research evidence supports their effectiveness and many where the evidence is insufficient to assess bene- fits and harms. This latter group, along with reviews in which the authors recommend restricting an interven- tion to use in research, provide examples of uncertain- ties which could be resolved through randomised trials. Author details 1 All-Ireland Hub for Trials Methodology Research, Queen’s University Belfast, Northern Ireland. 2 UK Cochrane Centre, National Institute for Health Research, Oxford, UK. Published: 13 December 2011 References 1. Clarke M: Doing new research? Don’t forget the old: nobody should do a trial without reviewing what is known. PLoS Medicine 2004, 1:100-102. 2. Allen C, Richmond K: The Cochrane Collaboration: International activity within Cochrane Review Groups in the first decade of the twenty-first century. Journal of Evidence Based Medicine 2011, 4:2-7. doi:10.1186/1745-6215-12-S1-A49 Cite this article as: Clarke et al.: Cochrane systematic reviews as a source of information for practice and trials. Trials 2011 12(Suppl 1):A49. * Correspondence: [email protected] 1 All-Ireland Hub for Trials Methodology Research, Queen’s University Belfast, Northern Ireland Full list of author information is available at the end of the article Clarke et al. Trials 2011, 12(Suppl 1):A49 http://www.trialsjournal.com/content/12/S1/A49 TRIALS © 2011 Clarke et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Transcript of Cochrane systematic reviews as a source of information for practice and trials
ORAL PRESENTATION Open Access
Cochrane systematic reviews as a source ofinformation for practice and trialsMike Clarke1*, Thomas T Clarke2, Lorcan Clarke2
From Clinical Trials Methodology Conference 2011Bristol, UK. 4-5 October 2011
BackgroundSystematic reviews should be used to provide the ethical,scientific and environmental justification for a new ran-domised trial [1]. The Cochrane Collaboration is theworld’s largest organisation dedicated to preparing andmaintaining systematic reviews of the effects of health-care interventions [2]. These are published in theCochrane Database of Systematic Reviews (CDSR) and allCochrane Reviews have a rigid structure, which includesthe authors’ conclusions on the implications for practice.Therefore, this collection of reviews provides a readilyavailable source of information on the evidence base forthe use of a large number of interventions in health care.
ObjectivesWe assessed all new and updated reviews in the firsttwelve monthly issues of CDSR from February 2010 toJanuary 2011 to identify their relevance to the evidencebase for current practice and for future trials to resolvecontinuing uncertainties.
MethodsAt least two authors independently examined the impli-cations for practice in the authors’ conclusions of eachnew and updated review in issues 2-12 2010 and issue 12011 of CDSR. Each review was coded to indicatewhether its authors concluded that a specific interven-tion should only be used in research, was not supportedor refuted by the evidence in the review, had beenshown to be effective, or should not be used in practice(or could not be recommended). Each review was alsocoded by area of health or health care. The final deci-sions on coding were taken by one author.
ResultsThese 12 monthly issues of CDSR contained 390 newand 462 updated reviews, many of which provide evi-dence on more than one intervention. The authors of25 (2.9%) of these reviews concluded that an interven-tion should only be used in research and 494 (58.0%)concluded that the evidence for an intervention wasinsufficient to support or refute its use. At least oneintervention in 413 (48.5%) of these reviews was judgedto be effective by the review authors and the authorsconcluded that an intervention should not be used orcould not be recommended in 139 (16.3%) reviews.
ConclusionsCochrane Reviews identify many interventions for whichthe research evidence supports their effectiveness andmany where the evidence is insufficient to assess bene-fits and harms. This latter group, along with reviews inwhich the authors recommend restricting an interven-tion to use in research, provide examples of uncertain-ties which could be resolved through randomised trials.
Author details1All-Ireland Hub for Trials Methodology Research, Queen’s University Belfast,Northern Ireland. 2UK Cochrane Centre, National Institute for HealthResearch, Oxford, UK.
Published: 13 December 2011
References1. Clarke M: Doing new research? Don’t forget the old: nobody should do a
trial without reviewing what is known. PLoS Medicine 2004, 1:100-102.2. Allen C, Richmond K: The Cochrane Collaboration: International activity
within Cochrane Review Groups in the first decade of the twenty-firstcentury. Journal of Evidence Based Medicine 2011, 4:2-7.
doi:10.1186/1745-6215-12-S1-A49Cite this article as: Clarke et al.: Cochrane systematic reviews as asource of information for practice and trials. Trials 2011 12(Suppl 1):A49.* Correspondence: [email protected]
1All-Ireland Hub for Trials Methodology Research, Queen’s University Belfast,Northern IrelandFull list of author information is available at the end of the article
Clarke et al. Trials 2011, 12(Suppl 1):A49http://www.trialsjournal.com/content/12/S1/A49 TRIALS
© 2011 Clarke et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.
