Significations et usages de Cochrane_Collaboration

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The Cochrane Collaboration
Motto	Working together to provide the best evidence for health care
Formation	1993 (1993)
Type	International NPO
Purpose/focus	Health care information
Headquarters	Oxford, England
Region served	Worldwide
Official languages	English
Steering Group Co-Chairs	Jeremy Grimshaw, Jonathan Craig[1]
Volunteers	Over 28,000 as of 2011[2]
Website	www.cochrane.org

The Cochrane Collaboration is an independent nonprofit organization consisting of a group of over 28,000 volunteers in more than 100 countries.^[3] The collaboration was formed in response to a felt need to organize medical research information in a systematic way. Such organized information constitutes evidence for medical decision making. Evidence is required to make effective health care decisions and to understand where more research is actually needed.^[4]

The Collaboration aims to provide compiled scientific evidence to aid well informed health care decisions. It conducts systematic reviews of randomized controlled trials of health care interventions and tries to disseminate the results and conclusions derived from them.^[5][6] A few more recent reviews have also studied the results of non-randomized, observational studies. The systematic reviews are published in the Cochrane Library.

The collaboration gained official relations with the World Health Organization in January 2011 as a partner NGO and a seat on the World Health Assembly to provide inputs on WHO resolutions.^[7][8]

  Goals and principles

The goal of the collaboration is to help people make well informed decisions about health care by preparing, maintaining and ensuring the accessibility of systematic reviews of the effects of health care interventions. The principles of the Cochrane Collaboration are:^[9]

• collaboration
• "building on the enthusiasm of individuals"
• avoiding duplication
• minimizing bias
• keeping up to date
• striving for relevance
• promoting access
• ensuring quality
• continuity
• enabling wide participation

  Structure

• Review Groups and authors - Prepare, maintain and update Cochrane Systematic Reviews
• Method groups - Frame and improve the methodology for conducting Systematic Reviews
• Fields - Work on the applicability of Cochrane reviews.
• Consumer Network - A community forum with specific relevance to Patients or Health care consumers
• Steering group - Is the primary governing body of the collaboration

^[10]

  Logo

The logo of the Cochrane Collaboration illustrates a meta analysis of data from seven randomized controlled trials (RCTs), comparing one health care treatment with a placebo in a forest plot. The diagram shows the results of a systematic review and meta analysis on inexpensive course of corticosteroid given to women about to give birth too early – the evidence on effectiveness that would have been revealed had the available RCTs been reviewed systematically a decade later. This treatment reduces the odds of the babies of such women dying from the complications of immaturity by 30–50%. Because no systematic review of these trials had been published until 1989, most obstetricians had not realised that the treatment was so effective and therefore many premature babies have probably suffered or died unnecessarily.^[11]

  History

The Cochrane Collaboration was founded in 1993 under the leadership of Iain Chalmers. It was developed in response to Archie Cochrane's call for up-to-date, systematic reviews of all relevant randomized controlled trials of health care. Cochrane's suggestion that the methods used to prepare and maintain reviews of controlled trials in pregnancy and childbirth should be applied more widely was taken up by the Research and Development Programme, initiated to support the United Kingdom's National Health Service. Through the NHS R&D programme, led by the first Director of Research and Development Professor Michael Peckham,^[12] funds were provided to establish a 'Cochrane Centre', to collaborate with others, in the UK and elsewhere, to facilitate systematic reviews of randomized controlled trials across all areas of health care.^[13]

In October 1995, The Collaboration formed the Cochrane Consumer Network^[14] to incorporate patient perspectives into the review process. Shortly thereafter, new 'plain language summaries' provided users with a jargon-free synopsis of each systematic review.^[15]

  Critiques

A 2004 editorial published in the journal CMAJ noted that Cochrane reviews appear to be more updated and of better quality than other reviews and due to their standardized methodologies, was "the best single resource for methodologic research and for developing the science of meta-epidemiology." Their work has also led to methodological improvements in the medical literature. However, the editorial also noted areas for improvement remained, including adequately assessing potential harms from medical interventions and providing a more user friendly format as well as promoting international collaboration. ^[16]

A 2011 study done to disclose possible conflicts of interests in underlying research studies used for medical meta-analyses reviewed 29 meta-analyses and found that conflicts of interests in the studies underlying the meta-analyses were rarely disclosed. The 29 meta-analyses included 11 from general medicine journals; 15 from specialty medicine journals, and 3 from the Cochrane Database of Systematic Reviews. The 29 meta-analyses reviewed an aggregate of 509 randomized controlled trials (RCTs). Of these, 318 RCTs reported funding sources with 219 (69%) industry funded. 132 of the 509 RCTs reported author conflict of interest [COI] disclosures, with 91 studies (69%) disclosing industry financial ties with one or more authors. The information was, however, seldom reflected in the meta-analyses. Only two (7%) reported RCT funding sources and none reported RCT author-industry ties. The authors concluded “without acknowledgement of COI due to industry funding or author industry financial ties from RCTs included in meta-analyses, readers’ understanding and appraisal of the evidence from the meta-analysis may be compromised.” Noting that most assessment tools for meta-analysis do not include a domain for study funding source the authors state: “Currently, The Cochrane Collaboration’s Risk of Bias tool includes an optional 'other sources of bias' domain, which meta-analysts could use to include information on COIs. We recommend that The Cochrane Collaboration consider formalizing the requirement to assess potential bias from COIs.”^[17]

  See also

• Evidence-based medicine
• Cochrane Library
• Systematic review

  References

  External links

• The Cochrane Collaboration web site Home.
• Most popular 50 Cochrane reviews
• Cochrane Consumer Network web site