1. Dr Peter French Cochrane Collaboration Reviews Dr Peter French Department of Nursing & health Sciences Hong Kong Polytechnic University

2. Dr Peter French Climate of Health Care Research u what is the place of science in health care? –which particular sort of science u how do we manage knowledge? –technical and sociological u what changes (esp cultural) do we need to implement ? u What are the methods of implementing change –what and where and with whom are the incentives? Modified from: Walshe, K. and Ham, C. Acting on the Evidence: progress in the NHS, NHS Confed/abpi, 1997.

3. Dr Peter French What are the problems with using (primary) research in everyday practice ? u how do we find it? – Access: how can we be sure we have found it all/too much? (Quantity) u what do we do with it once found? – Appraisal: how can we make sense of it all? (Quality) –Storing it: for later referral/use/sharing.. u how do we communicate/implement...?

4. Dr Peter French What is evidence? Evidence is: the available facts, circumstances etc supporting or otherwise a belief or proposition etc or indicating whether or not a thing is true or valid (Oxford Modern English Dictionary). Assumption: that the concept of evidence is a scientific construct

5. Dr Peter French Evidence-based medicine is the conscientious and explicit use of the most appropriate and current valid evidence in

6. Dr Peter French Origins of Evidence-based HC Archie Cochrane in UK said that it is a great criticism of our profession that we have not organised a critical summary by specialty or sub- specialty, adapted periodically, of all relevant randomised controlled trials (Cochrane 1979)

7. Dr Peter French Professor Archie Cochrane called for ‘the preparation, maintenance and dissemination of systematic reviews in all fields of health care (Cochrane 1979)

8. Dr Peter French The Cochrane Collaboration Launched in 1993 based on Archie Cochrane’s idea that health care should deliver care which research has shown to be effective. He called for systematic reviews of randomized controlled trails of health care.

9. Dr Peter French Types of Research Evidence 1. Primary research 2. Secondary research

10. Dr Peter French Examples of Secondary Research u Cochrane Collaboration and Library u The Joanna Briggs Institute of Evidence-based Nursing u J. EBM on CD Evidence-based Nursing (J)

11. Dr Peter French Cochrane Reviews Use the technique of meta analysis to pool the results of trials. They are designed to keep people up to date in their practice. Assumption 1: that sufficient previous research exists to undertake meta-analysis Assumption 2 : that all `research’ is amenable to meta- analysis Assumption 3: that a definative conclusion is always possible.

12. Dr Peter French Principles of the Cochrane Collaboration -1 u Collaboration by internally & externally good communications, open decision making and team work u Avoiding duplication, by good management and co-ordination to maximise economy of effort u Minimising bias through a variety of approaches u Keeping up to date by obtaining commitment from initial reviewers

13. Dr Peter French Principles of Cochrane Collaboration - 2 u Striving for relevance by overt linkage to current health care concerns/outcomes u Promoting access by disseminating the outputs of the Collaboration, electronic data bases/media. u Ensuring quality by systematic peer & group review u Continuity by ensuring that responsibilty for reviews, editorial processes & key functions is maintained & renewed

14. Dr Peter French Systematic Reviews “Clinical review articles should be as scientific as the articles they review” Haynes, BMJ 1992; 304: 330-1 “ The fundamental difference between a review and a primary study is the unit of analysis, not the scientific principles that apply” Oxman & Guyatt, CMAJ 1988; 138: 697-703

15. Dr Peter French The Cochrane Review Process u Register title u Send protocol for approval u Conduct review u Send review for assessment u Act on assessment results u Entry to Cochrane Library u 2 year review.

16. Dr Peter French More detailed information RCN UK www.man.ac.uk/rcn/ Mc Master University. hiru.mcmaster.ca/cochrane/