Cochrane Collaboration: From 1 Different Sources
A non-pro?t-making international organisation which systematically ?nds, appraises and reviews available evidence, mainly from randomised CLINICAL TRIALS, about the consequences of health care. The aim is to help people make well-informed decisions about health care. The main work is done by around 50 review groups, the members of which share an interest in generating reliable, up-to-date evidence on the prevention, treatment and rehabilitation of particular health problems or groups of problems. The UK Cochrane Centre opened in Oxford in 1992 and the International Collaboration launched a year later. Its origins lay in the work of a UK epidemiologist, Dr Archie Cochrane, who in 1979 published a monograph calling for a systematic collection of randomised controlled trials on the e?ect of health care.
The main output of the Cochrane Collaboration is published electronically as the Cochrane Library, updated quarterly, with free access in many countries. (See CLINICAL TRIALS, EVIDENCE-BASED MEDICINE and Appendix 2.)
The joint utilisation of engineering and biological knowledge to illuminate normal and abnormal functions of the human body. Blood ?ow, the reaction of bones and joints to stress, the design of kidney dialysis machines, and the development of arti?cial body parts are among the practical results of this collaboration.... biomechanical engineering
(See EVIDENCE-BASED MEDICINE.) Clinical trials aim to evaluate the relative effects of di?erent health-care interventions. They are based on the idea that there must a fair comparison of the alternatives in order to know which is better. Threats to a fair comparison include the play of chance and bias, both of which can cause people to draw the wrong conclusions about how e?ective a treatment or procedure is.
An appreciation of the need to account for chance and bias has led to development of methods where new treatments are compared to either a PLACEBO or to the standard treatment (or both) in a controlled, randomised clinical trial. ‘Controlled’ means that there is a comparison group of patients not receiving the test intervention, and ‘randomised’ implies that patients have been assigned to one or other treatment group entirely by chance and not because of their doctor’s preference. If possible, trials are ‘double-blind’ – that is, neither the patient nor the investigator knows who is receiving which intervention until after the trial is over. All such trials must follow proper ethical standards with the procedure fully explained to patients and their consent obtained.
The conduct, e?ectiveness and duplication of clinical trials have long been subjects of debate. Apart from occasional discoveries of deliberately fraudulent research (see RESEARCH FRAUD AND MISCONDUCT), the structure of some trials are unsatisfactory, statistical analyses are sometimes disputed and major problems have been the – usually unwitting – duplication of trials and non-publication of some trials, restricting access to their ?ndings. Duplication occurs because no formal international mechanism exists to enable research workers to discover whether a clinical trial they are planning is already underway elsewhere or has been completed but never published, perhaps because the results were negative, or no journal was willing to publish it, or the authors or funding authorities decided not to submit it for publication.
In the mid 1980s a proposal was made for an international register of clinical trials. In 1991 the NHS launched a research and development initiative and, liaising with the COCHRANE COLLABORATION, set out to collect systematically data from published randomised clinical trials. In 1994 the NHS set up a Centre for Reviews and Dissemination which, among other responsibilities, maintains a database of research reviews to provide NHS sta? with relevant information.
These e?orts are hampered by availability of information about trials in progress and unpublished completed trials. With a view to improving accessibility of relevant information, the publishers of Current Science, in 1998, launched an online metaregister of ongoing randomised controlled trials.
Subsequently, in October 1999, the editors of the British Medical Journal and the Lancet argued that the case for an international register of all clinical trials prior to their launch was unanswerable. ‘The public’, they said, ‘has the right to know what research is being funded. Researchers and research funders don’t want to waste resources repeating trials already underway.’ Given the widening recognition of the importance to patients and doctors of the practice of EVIDENCE-BASED MEDICINE, the easy availability of information on planned, ongoing and completed clinical trials is vital. The register was ?nally set up in 2005.... clinical trials
Organized collaboration, as necessary, among those providing the services at the same and different levels of the health system in order to make the most efficient use of resources, as well as within and among the various categories of health workers following agreement on the division of labour. It also means coordination of programmes or services to avoid duplication or inconsistency.... coordination within the health sector
The process of systematically identifying, appraising and using the best available research ?ndings, integrated with clinical expertise, as the basis for clinical decisions about individual patients. The aim is to encourage clinicians, health-service managers and consumers of health care to make decisions, taking account of the best available evidence, on the likely consequences of alternative decisions and actions. Evidence-based medicine has been developing internationally for the past 25 years, but since around 1990 its development has accelerated. The International COCHRANE COLLABORATION ?nds and reviews relevant research. Several other centres have been set up to look at the clinical application of research results, including the Centre for Evidence-Based Medicine in Oxford.... evidence-based medicine
A coherent set of methods and models, on the funding, administrative, organizational, service delivery and clinical levels, designed to create connectivity, alignment and collaboration within the health sector.... integration
(PAR) a radical approach to public health issues that actively involves communities in collaboration, reflection, data collection, and activities that empower them to improve their own health. See empowerment.... participatory action research
a policy of actively and continuously improving patient care, with an emphasis on interprofessional collaboration and the integration of evidence-based practice with *person-centred care.... practice development
A development of systematic reviews of randomised, controlled trials in particular ?elds of health care. If this re-evaluation of the ?ndings of primary research also includes the aggregation of data from all the re-evaluated studies and a re-analysis of them, the procedure is described as meta-analysis. The technique has been used increasingly in medicine in recent years, and the COCHRANE COLLABORATION has been in the forefront of systematically reviewing and storing clinical and research data to provide a reliable information base on which to take forward the practice of EVIDENCE-BASED MEDICINE. Bias in medical research – because, say, of an inadequately planned statistical base or only small numbers in a trial – is not uncommon, and meta-analysis of a group of broadly similar trials can provide more reliable data and reduce the risk of erroneous conclusions.... meta-analysis
n. possession of a high level of intellectual and technical expertise with a commitment to public service and the ability to practise autonomously within the regulations of the discipline. It calls for a special set of *values, behaviours, and relationships including respect and care for oneself as well as patients and others, honesty, *integrity, reliability, *responsibility, communication, collaboration, *compassion, *empathy, altruism, and *advocacy – but also self-awareness and a knowledge of limits (see burnout). Major shortcomings might be reported to a professional body (such as the *General Medical Council for UK doctors).... professionalism
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