Showing papers by "Cochrane Collaboration published in 1994"

Reporting, updating, and correcting systematic reviews of the effects of health care.

Abstract: The recent growth in the numbers of published systematic reviews reflects growing recognition of their importance for improving knowledge about the effects of health care. In Britain the NHS R&D Programme has established two centres to prepare systematic reviews of existing information, and the Cochrane Collaboration--an international network of individuals and institutions--evolved to produce systematic, periodically updated reviews of randomised controlled trials. The large amount of existing evidence that needs to be considered creates a problem for the reporting of systematic reviews: the need to ensure that methods and results of systematic reviews are adequately described has to be reconciled with the limited space available in printed journals. A possible solution is the use of electronic publications: reviews could be published simultaneously in a short, printed form and in a more detailed electronic form. Electronic publications also have the advantage of the ease with which reviews may be updated as new evidence becomes available or mistakes are identified.

The Cochrane Collaboration: the role of the UK Cochrane Centre in identifying the evidence.

Abstract: This paper attempts to explain why systematic reviews of randomized controlled trials, based on as high a proportion as possible of the relevant studies, are so important in generating reliable information for evidence-based decision making within health care. The preparation, maintenance and dissemination of such reviews is the challenge which has been taken up by the Cochrane Collaboration. The first phase of data collection is the identification of relevant studies. Currently, bibliographic databases are inadequate for this task. MEDLINE searches identify on average only about half of the relevant studies, and until 1994 there were no suitable indexing terms in EMBASE to identify randomized controlled trials. Co-operation between the Cochrane Collaboration and both the National Library of Medicine and Elsevier, however, is already transforming this situation. From January 1994 a new indexing term has been added to EMBASE to help identify randomized controlled trials. From January 1995 a new indexing term will be added to MEDLINE to help identify controlled trials where the method of allocation to treatment or control cannot be described with certainty as being randomized. Also from January 1995 an additional 20,000 reports will be identifiable as randomized controlled trials in MEDLINE. Progress during the first 2 years of the Cochrane Collaboration has been encouraging, but much remains to be done if users of health services are to benefit from the evidence-based health care which they deserve.

The Windermere Lecture 1994. The line between 'knowing' and 'doing': medicine's dilemma at the end dilemma at the end of the twentieth century.

Abstract: Correspondence to: Professor W A Silverman, 90 La Cuesta Drive, Greenbrae, California 94904, USA. MEDICAL PROFESSION In the profession of medicine, the two types of occupation are assigned to one general class; but the conditions for the establishment and the maintenance of the two subclasses are, in fact, quite different. They need to be examined separately. For example, medicine first attained the status of a learned profession in the Middle Ages. Recognition followed the rise of the university in Europe, and the increased importance of learning as perceived by the elite. The university trained doctors gained the support of the state, which granted them the authority to be the sole arbiters ofmedical work. But medicine did not become a consulting profession, to any important extent, until the work itself became attractive to the public. Widespread acknowledgment took place less than 150 years ago it followed the construction of an increasingly solid scientific foundation (particularly after acceptance of the germ theory of disease). Only then did the work of medicine begin to be widely seen as superior to the ministrations of a colourful variety of self proclaimed healers. Before these relatively recent developments, university trained physicians were unable to claim a monopoly over the work of healing. The certified doctors were unable to attract widespread public confidence. The distinction between scholar and practitioner was, and is, still seen most clearly at the bedside. When problems are brought to them, frontline doctors behave like engineers. In both of these consulting professions, practitioners are obliged to act on the basis of incomplete knowledge. These pragmatists simply have to manage with as much truth as is currently available to them action in the applied sciences is always an informed compromise. And we must admit that as compared with our small pond of knowledge in medicine, our ignorance is Atlantic.

Designing a “Learning Building”

Abstract: In 1991, a group of eight companies, four from the UK and four Scandinavian, formed a working agreement to explore the workplace needs of user organizations and find integrated commonsense solutions to meet these evolving needs. So the Learning Building Group (LBG) was formed. Towards the end of 1991 the LBG commissioned research with the following objectives: to establish new workplace development processes and solutions which meet current and changing business needs; and to establish the feasibility, costs and benefits of processes and solutions. This review identified that new concepts were required for the procurement and production of buildings, as well as for the buildings′ design. Discusses some of the proposals which emanated from “The Workplace Design Priorities” study led by Wes McGregor, of Cochrane McGregor. This study was one of three parallel studies commissioned by the LBG – the others being “Technical Priorities” and “Cost Benefits” – the conclusions of which lead to the realization that t...

An Integrated Workplace Process

Abstract: In 1991, a group of eight companies, four from the UK and four Scandinavian, formed a working agreement to explore the workplace needs of user organizations and find integrated commonsense solutions to meet these evolving needs. So the Learning Building Group (LBG) was formed. Towards the end of 1991, the LBG commissioned consultants Cochrane McGregor to undertake research with the objectives of establishing new workplace development processes and solutions which meet current and changing business needs; and establishing the feasibility, costs and benefits of processes and solutions. Discusses some of the social and commercial dynamics which the study, led by Wes McGregor, concluded. Calls for an integrated approach to the workplace and its design, production, procurement and operation.