Wednesday 28 January 2015

Trials Week: The Cochrane Collaboration – Evidence and practice

It may surprise you to learn that what takes place in the lab or on the ward is only the tip of the iceberg. As part of our joint Clinical Trials Week, today we and our friends at cf/Aware are each offering an insight into the vital work that goes on elsewhere to inform and sometimes form the basis for, a clinical research project.

Here Nikki Jahnke, Managing Editor of Cochrane Cystic Fibrosis & Genetic Disorders Group, talks about the work of the Cochrane Review. 

There are thousands of clinical trials being run across the world, so how can your doctor keep up with all their findings and make sure you get the best treatment? It would mean reading hundreds of articles in so many journals that there wouldn’t be any time to see patients! This is why we work to include the findings from randomised controlled trials - the best type of trial design for establishing whether a treatment works or not – in systematic reviews.

Why are they called systematic reviews? Because we work systematically through databases and journals to make sure we capture all the available evidence for a particular topic, like ‘inhaled antibiotics for pulmonary exacerbations’. Once we identify the relevant trials, two independent authors record all the information they need from the trial reports and collate it in a single review. By combining data from a number of similar trials we can be more confident that our findings really are due to the effects of the treatment and not just chance. Our reviews also consider if there are factors that might affect the results of the trials. We make recommendations for doctors and other healthcare workers to use in daily practice, which can inform patients when discussing treatment options with their doctors.

If we don’t find any trials that help us answer our research question, we add a plan to our review describing how we think trials should be designed to provide us with the information we need. Many agencies ask for a systematic review to be undertaken before they agree to fund new trials. The review will show if the trial needs to be run, ie because there is either no or little evidence, and indicate how it should be designed. An example of this is the review looking at antibiotic strategies to eradicate infection with Pseudomonas aeruginosa in people with cystic fibrosis. Our original review found some trials, but the findings were not conclusive. So we recommended that a new trial should be run with more people. The TORPEDO trial is now underway and when it is finished we will be able to update our review with the results.

Finally, how do we decide on what questions to ask and which topics to investigate? For this we rely partly on our volunteer authors (doctors and other healthcare workers), but we also ask people who have CF to tell us what questions they want answered. This is where you can really get involved in driving research that will directly affect you. Take a look at the 75 CF reviews we have published so far and let us know what we should look at next.
Visit cf/Aware's Facebook page this afternoon to hear from Rebecca Cosgriff, Registry Lead at the Cystic Fibrosis Trust, about the work of the UK CF Registry.

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