Over the past two decades, the International Cochrane Collaboration has completely transformed the mechanism of health decision-making. Cochrane aims to collect, summarize and disseminate the best current research evidence via The Cochrane Library in order to help stakeholders making informed health care decisions. Cochrane began with just a few dozen volunteers and has, over the years, transformed into a truly global and inclusive network, with 37 000 contributors from over 130 countries. Cochrane evidence has long been recognized as high quality and trustworthy international gold standard in health care. In recent years, Cochrane has initiated a number of innovative projects to attract more researchers from different socio-cultural and educational backgrounds. This commentary introduces these new platforms and illustrates the opportunities offered to Chinese researchers by the modern-era Cochrane.
Objective To analyze the methodological quality of clinical practice guideline mentioned “evidence-based” in China. Methods We selected clinical guidelines developed based on evidence issued by the Chinese Medical Association in 2010-2012, and meanwhile, we conducted additional search for guidelines on clinical major diseases. Then, we selected literature according to the inclusion and exclusion criteria and evaluated the included guidelines according to 8 items relevant to methodological rigor which were selected from the Appraisal of Guidelines for Research and Evaluation (AGREE II). If the guidelines comply with the item, we recorded 1 point, otherwise 0 point. Results a) Among twenty-two included guidelines, 13 were originated and 9 were updated once every 3 to 5 years. b) Diseases covered stroke, diabetes, chronic hepatitis B, hypertension, pediatric nutrition, etc. c) The number of guideline references were 10 to 218, of which, nine guidelines cited 24 Cochrane systematic reviews (CDSRs), accounted for 2.62% (24/916). Among them, the acute ischemic stroke guideline cited the most (7 CDSRs). d) The number of experts involved in guidelines development was 2 to 95 and guidelines pages were 4 to 150. e) The guidelines’ quality generally scored 4 to 7, most of which described the process of guidelines development. The grades of recommendation were consistent with the levels of evidence. But most of the included guidelines did not clearly described literature research methods, peer reviewer, and update procedures. Conclusion There is a growing trend that clinical guidelines are developed based on evidence in China. However, the quality of reporting and the methodological rigor of guidelines need further improvement. The citation rates of Cochrane systematic reviews in these guidelines were relatively low. We suggest that guideline recommendations should be consistent with the levels of evidence and adapt to local conditions, and relevant support policies for guideline implementation in practice. In future, attention should be paid to the aspects of guideline development methods, reporting standard, guideline accessibility, and standard training for relevant personnel.
Objective To assess the effects on labour, maternal, and neonatal outcomes of different techniques and drugs for analgesia during labour. Methods We searched The Cochrane Library (Issue 4, 2006) , MEDLINE (Jan. 1978 to Oct. 2006) and CBMdisc (Jan. 1980 to Oct. 2006) to collect the current best evidence of labor analgesia. Results We included eight Cochrane systematic reviews and six other meta-analyses. The evidence showed that epidural analgesia was associated with a longer second stage of labour, more frequent oxytocin augmentation, higher incidence of instrumental vaginal delivery and maternal fever. But it was unlikely to increase the risk of caesarean section. Conclusion Epidural analgesia is superior to other approaches.
Objects To retrospectively analyze the accepted abstracts by the Cochrane Colloquiums in recent 5 years, so as to learn the advances and development trend for next stage in evidence-based medicine field. MethodsAbstracts accepted by the 19th to 23rd Cochrane Colloquiums were collected, and relevant information was extracted. Then, a descriptive analysis was conducted. Outcomes A total of 2088 abstracts were accepted in recent five Cochrane Colloquiums. Europe contributed the most abstracts, in the top 10 contribution countries, five countries were located in Europe. Colleges/Universities were the major contributing institutes, McMaster University of Canada (165, 7.90%) and Lanzhou University of China (118, 5.65%) were the top two contributing institutions. The number of authors of most accepted abstracts were 3 to 5(1011, 48.42%). The top three topics focused by these abstracts were evidence (417, 19.97%), methodology (412, 19.73%) and risk of bias (220, 10.54%). ConclusionsEuropean countries are major contributing countries of abstracts of the Cochrane Colloquium, and colleges/universities are the major contributing institutions. Retrieval and methodology are research hot in recent 5 years. Attention should be paid to breakthrough progress in methodology in future.
Objective To detect the false-negative results of cumulative meta-analyses of Cochrane Urology Group with the trial sequential analysis (TSA). Methods The Urology Group of The Cochrane Library (Issue 6, 2016) was searched to collect meta-analyses with negative results. Two researchers independently screened literature and extracted data of included meta-analyses. Then, TSA was performed using TSA software version 0.9 beta. Results A total of 11 papers involving 12 meta-analyses were included. The results of TSA showed that, four (33%) out of 12 meta-analyses were potentially false-negative results for failing to surpass the trial sequential monitoring boundary and to reach the required information size. Conclusion Some of the negative results of systematic reviews from Cochrane Urology Group was false-negative. TSA can help researchers to identify the false-negative results of meta-analyses.
Objective To analyze acupuncture resources in the Cochrane Database of Systematic Reviews (CDSR). Methods We identified acupuncture literature from CDSR (2008 year) electronically. W analyzed this literature by research time date, author, study contents, and conCochrane Library usions.?Results?? ? We initially found 82 articles. Finally, we identified 67 systematic reviews. The number of acupuncture articles has increased all over the world with higher growth rate in China than overseas. The disease spectrum of acupuncture treatment increased widely, focusing on nervous system diseases and pain diseases. Eight articles (25.8%) definitely supported the efficacy of acupuncture. Twenty two articles (71%) considered the efficacy of acupuncture as uncertain owning to insufficient evidence. Just one article expressed that acupuncture treatment was ineffective according to current evidence.
Objective To explore the differences between large and small studies in rare events meta-analysis. Methods Empirical data were collected from The Cochrane Systematic Review Database from January 2003 to May 2018. Meta-analyses with rare events, binary outcomes involving at least 5 studies, and at least 1 large study were screened. Peto and classical ORs were used to compare the magnitude, direction and P-value. Results A total of 214 meta-analyses were included. Among 214 pairs of ORs of large and small studies, 66 pairs (30.84%) were inconsistent in the direction of ORs based on Peto OR (Kappa =0.33), and 69 pairs (32.24%) were inconsistent in the direction of ORs based on classical OR. The Peto ORs resulted in smaller P-values compared to classic ORs in a substantial (83.18%) number of cases. Conclusion There are considerable differences between large and small studies in the results of meta-analysis of rare events.
Backgroud Iodine deficiency is the main cause for potentially preventable mental retardation in childhood and is still prevalent in large parts of the world. Objectives To assess the effects of iodised salt in comparison with other forms of iodine supplementation or placebo in the prevention of iodine deficiency disorders.Search strategy We searched the Cochrane Library, Medline, the Register of Chinese trials developed by the Chinese Cochrane Centre, and the Chinese Med Database. We performed handsearching of a number of journals (Chinese Journal of Control of Endemic Diseases, Chinese Journal of Epidemiology, Chinese Journal of Preventive Medicine, and Studies of Trace Elements and Health up to February 2001), and searched reference lists, databases of ongoing trials and the Internet. Date of latest search: November 2001. Selection Criteria We included prospective controlled studies of iodised salt versus other forms of iodine supplementation or placebo in people living in areas of iodine deficiency. Studies reported mainly goitre rates and urinary iodine excretion as outcome measures. Data collection amp; analysis As the studies identified were not sufficiently similar and not of sufficient quality, we did not do a meta-analysis but summarised the data in a narrative format. Main results We found six prospective controlled trials relating to our question. Four of these were described as randomised controlled trials, one was a prospective trial that did not specify allocation to comparison groups, and one was a large population-based study comparing different interventions. Comparison interventions included non-iodised salt, iodised water, iodised oil, iodation with potassium iodide versus potassium iodate. Numbers of participants in the trials ranged from 35 to 334; over 20 000 people were included in the population-based study. There was a tendency towards goitre reduction with iodised salt, although this was not significant in all studies. There was aim an improved iodine status in most studies (except in small children in one of the studies), although urinary iodine excretion did not always reach the levels recommended by the WHO. Reviewers’ conclusions The results suggest that iodised salt is an effective and safe means of improving iodine status. However, high quality controlled studies are needed to address questions of dosage and best means of iodine supplementation in different population groups.