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Systematic Reviews,

Systematic Reviews,. The Cochrane Collaboration. Michele L. Hales University of Alberta Edmonton, AB CANADA. Dubai, U.A.E. October 2 nd & 3 rd , 2003. The Cochrane Collaboration.

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Systematic Reviews,

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  1. Systematic Reviews, The Cochrane Collaboration Michele L. Hales University of Alberta Edmonton, AB CANADA Dubai, U.A.E. October 2nd & 3rd, 2003

  2. 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

  3. The Collaboration is being built on a set of eight values: • 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

  4. 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.

  5. Brief History • The first systematic reviews were in the field of Pregnancy and Childbirth. • Increased interest from professional groups, health managers, and government organisations in extending the scope of systematic reviews. • The Cochrane Database of Systematic Reviews is now published quarterly in the electronic journal The Cochrane Library.

  6. Cochrane Centres • Cochrane Centres have been established in a number of countries world-wide, funded by both government and charitable sources. • Responsible for maintaining registers of known randomised controlled trials, complete systematic reviews as well as current and potential contributors to the Collaboration. • Provide advice and training to those who contribute to the Collaboration .

  7. The Cochrane Renal Group (CRG) • The Cochrane Renal Group (CRG) began March 1, 1997. • 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.

  8. What is a systematic review? A reviewer must: • identify an intervention for a specific disease, and ask whether or not this intervention works. It’s accomplished by: • locating, reviewing and assessing evidence from as many relevant scientific studies as possible. • summarising the conclusion with respect to its effectiveness • 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.

  9. Validity Guide of the SR • Is this a systematic review of randomised trials? • Does this systematic review have a “methods” section that describes: • Finding and including all relevant trials • How the validity of the individual studies was assessed? • Were the results consistent from study to study?

  10. 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? • 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?

  11. 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

  12. CRG’s Focus The Cochrane Renal Group's focus includes the following major areas of renal disease: • Acute renal failure • Chronic renal failure • Dialysis: both peritoneal and haemodialysis • Renal transplantation • Renovascular hypertension • Glomerular diseases • Urinary tract infections • Nephrolithiasis

  13. Areas of High Priority Renal Transplantation • 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 • Interventions to prevent peritonitis & exit site infections in peritoneal dialysis • Treatment for dialysis-related hypotension General Nephrology • 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

  14. Trials in Nephrology • Published Trials (4100) • Ongoing Trials (57)

  15. Current Trials • Acute Renal Failure (1) • Diabetic Nephropathy (4) • Dialysis (17) • General Nephrology (14) • Transplantation (17) • Urinary Tract Infection (3)

  16. Current Trials Acute Renal Failure (1) • Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Diabetic Nephropathy (4) • 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.

  17. Current Trials Cont’d Dialysis (17) • 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.

  18. Current Trials Cont’d General Nephrology (14) • 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.

  19. 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.

  20. 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

  21. Searches – Library Database • 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

  22. MeSH Thesaurus • 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

  23. The Renal Health Library It contains: • 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

  24. Renal Health Library CD May 2003 (1st Issue) • Contains over 4000 randomised controlled trials, including ongoing trials, with links to abstracts on PubMed and 36 full-text reviews in nephrology.

  25. 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: crg@chw.edu.au website: www.cochrane-renal.org

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