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Cochrane Collaboration

NonprofitOxford, United Kingdom
About: Cochrane Collaboration is a nonprofit organization based out in Oxford, United Kingdom. It is known for research contribution in the topics: Systematic review & Randomized controlled trial. The organization has 1995 authors who have published 3928 publications receiving 382695 citations.


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Journal ArticleDOI
TL;DR: The overall quality of the evidence was low to very low and the main limitations were serious risk of bias related to blinding of participants and personnel, indirectness and imprecision.
Abstract: Background Observational evidence suggests a potential benefit with several anti-adhesion therapies in women undergoing operative hysteroscopy (eg insertion of an intrauterine device or balloon, hormonal treatment, barrier gels or human amniotic membrane grafting) for decreasing intrauterine adhesions (IUAs) Objectives To assess the effectiveness of anti-adhesion therapies versus placebo, no treatment or any other anti-adhesion therapy, following operative hysteroscopy for treatment of female subfertility Search methods We searched the following databases from inception to June 2017: the Cochrane Gynaecology and Fertility Group Specialised Register; the Cochrane Central Register of Studies (CRSO); MEDLINE; Embase; CINAHL and other electronic sources of trials, including trial registers, sources of unpublished literature and reference lists We handsearched the Journal of Minimally Invasive Gynecology, and we contacted experts in the field We also searched reference lists of appropriate papers Selection criteria Randomised controlled trials (RCTs) of anti-adhesion therapies versus placebo, no treatment or any other anti-adhesion therapy following operative hysteroscopy in subfertile women The primary outcome was live birth Secondary outcomes were clinical pregnancy, miscarriage and IUAs present at second-look hysteroscopy, along with mean adhesion scores and severity of IUAs Data collection and analysis Two review authors independently selected studies, assessed risk of bias, extracted data and evaluated quality of evidence using the GRADE method Main results The overall quality of the evidence was low to very low The main limitations were serious risk of bias related to blinding of participants and personnel, indirectness and imprecision We identified 16 RCTs comparing a device versus no treatment (two studies; 90 women), hormonal treatment versus no treatment or placebo (two studies; 136 women), device combined with hormonal treatment versus no treatment (one study; 20 women), barrier gel versus no treatment (five studies; 464 women), device with graft versus device without graft (three studies; 190 women), one type of device versus another device (one study; 201 women), gel combined with hormonal treatment and antibiotics versus hormonal treatment with antibiotics (one study; 52 women) and device combined with gel versus device (one study; 120 women) The total number of participants was 1273, but data on 1133 women were available for analysis Only two of 16 studies included 100% infertile women; in all other studies, the proportion was variable or unknown No study reported live birth, but some (five studies) reported outcomes that were used as surrogate outcomes for live birth (term delivery or ongoing pregnancy) Anti-adhesion therapy versus placebo or no treatment following operative hysteroscopy There was insufficient evidence to determine whether there was a difference between the use of a device or hormonal treatment compared to no treatment or placebo with respect to term delivery or ongoing pregnancy rates (odds ratio (OR) 094, 95% confidence interval (CI) 042 to 212; 107 women; 2 studies; I² = 0%; very-low-quality evidence) There were fewer IUAs at second-look hysteroscopy using a device with or without hormonal treatment or hormonal treatment or barrier gels compared with no treatment or placebo (OR 035, 95% CI 021 to 060; 560 women; 8 studies; I² = 0%; low-quality evidence) The number needed to treat for an additional beneficial outcome (NNTB) was 9 (95% CI 5 to 17) Comparisons of different anti-adhesion therapies following operative hysteroscopy It was unclear whether there was a difference between the use of a device combined with graft versus device only for the outcome of ongoing pregnancy (OR 148, 95% CI 057 to 383; 180 women; 3 studies; I² = 0%; low-quality evidence) There were fewer IUAs at second-look hysteroscopy using a device with or without graft/gel or gel combined with hormonal treatment and antibiotics compared with using a device only or hormonal treatment combined with antibiotics, but the findings of this meta-analysis were affected by evidence quality (OR 055, 95% CI 036 to 083; 451 women; 5 studies; I² = 0%; low-quality evidence) Authors' conclusions Implications for clinical practice The quality of the evidence ranged from very low to low The effectiveness of anti-adhesion treatment for improving key reproductive outcomes or for decreasing IUAs following operative hysteroscopy in subfertile women remains uncertain Implications for research More research is needed to assess the comparative safety and (cost-)effectiveness of different anti-adhesion treatments compared to no treatment or other interventions for improving key reproductive outcomes in subfertile women

52 citations

Journal ArticleDOI
31 May 2013-PLOS ONE
TL;DR: Since 2007, WHO guideline development methods have become more systematic and transparent, however, some departments are bypassing the procedures, and as yet neither the GRC, nor the quality assurance standards they have set, are fully embedded within the organization.
Abstract: Background Research in 2007 showed that World Health Organization (WHO) recommendations were largely based on expert opinion, rarely used systematic evidence-based methods, and did not follow the organization's own “Guidelines for Guidelines”. In response, the WHO established a “Guidelines Review Committee” (GRC) to implement and oversee internationally recognized standards. We examined the impact of these changes on WHO guideline documents and explored senior staff's perceptions of the new procedures. Methods and Findings We used the AGREE II guideline appraisal tool to appraise ten GRC-approved guidelines from nine WHO departments, and ten pre-GRC guidelines matched by department and topic. We interviewed 20 senior staff across 16 departments and analyzed the transcripts using the framework approach. Average AGREE II scores for GRC-approved guidelines were higher across all six AGREE domains compared with pre-GRC guidelines. The biggest changes were noted for “Rigour of Development” (up 37.6%, from 30.7% to 68.3%) and “Editorial Independence” (up 52.7%, from 20.9% to 73.6%). Four main themes emerged from the interviews: (1) high standards were widely recognized as essential for WHO credibility, particularly with regard to conflicts of interest; (2) views were mixed on whether WHO needed a single quality assurance mechanism, with some departments purposefully bypassing the procedures; (3) staff expressed some uncertainties in applying the GRADE approach, with departmental staff concentrating on technicalities while the GRC remained concerned the underlying principles were not fully institutionalized; (4) the capacity to implement the new standards varied widely, with many departments looking to an overstretched GRC for technical support. Conclusions Since 2007, WHO guideline development methods have become more systematic and transparent. However, some departments are bypassing the procedures, and as yet neither the GRC, nor the quality assurance standards they have set, are fully embedded within the organization.

52 citations

Journal ArticleDOI
TL;DR: AAA screening in Sweden did not contribute substantially to the large observed reductions in AAA mortality, and the small benefit and substantially less favourable benefit-to-harm balance call the continued justification of the intervention into question.

52 citations

Journal ArticleDOI
TL;DR: The randomised trials suggest that antibiotics could be a useful treatment for leptospirosis and the indication for general use of antibiotics is uncertain, however, the evidence suggest that penicillin may cause more good than harm.
Abstract: Background Leptospirosis is an infectious disease transmitted by animals. Death occurs in about five per cent of the patients. In clinical practice, doxycycline is widely used for prevention. Objectives To evaluate the effectiveness and safety of any antibiotic regimen versus placebo or other antibiotic regimens in the prophylaxis of leptospirosis. Search strategy The sources used were: EMBASE, LILACS, MEDLINE, SCISEARCH, The Cochrane Controlled Trials Register, The Cochrane Hepato-Biliary Group Controlled Trials Register, bibliographies of published papers, and personal communication with authors. There were no language or date restrictions in any of the searches. Studies All randomised clinical trials in which antibiotics were used as prophylactic regimen for leptospirosis. Participants People potentially exposed to leptospirosis, such as people in endemic areas during the rainy season, health professionals and other professionals with high risk of infection. Intervention Any antibiotic regimen compared with a control group (placebo or another antibiotic regimen). Outcomes Infection (primary outcome) and adverse events (secondary outcome). Data collection and analysis Data were independently extracted and methodological quality of each trial was assessed by two reviewers as well as cross-checked. Details of the randomisation (generation and concealment), blinding, and the number of patients lost to follow-up were recorded. The results of each trial were summarised on an intention-to-treat basis in 2 x 2 tables for each outcome. Main results Two trials comparing doxycycline with placebo met the inclusion criteria. We did not find trials comparing doxycycline versus other antibiotics, or other antibiotics versus placebo. One of the trials had excellent methodological quality. In the other trial, the allocation concealment process, generation of allocation sequence, and blinding methods were not described.Of the 1022 participants enrolled, 509 were treated with doxycycline and 513 with placebo. Of these, 940 participants were soldiers included in one trial. The patients assigned to the antibiotics group compared with the ones assigned to the placebo group showed: Symptomatic, verified leptospirosis: 0.6% (3/509) versus 4.9% (25/ 513); risk difference (random effects model) -4.1%, 95% confidence interval -5.9% to -2.3%. Number needed-to-treat 24 (95% confidence interval 17 to 43). Adverse effects: 3% (13/469 participants) versus 0.2% (1/471 participants); random effects model 2.6%, 95% confidence interval 1.0% to 4.1%. Number needed-to-harm 39 (95% confidence interval 25 to 100). Authors' conclusions Prophylaxis of leptospirosis may be achieved by administration of doxycycline to soldiers training in endemic areas with a high risk of exposure to leptospirosis. Whether these findings apply to other scenarios or not remains to be proven.

52 citations

Journal ArticleDOI
TL;DR: Although most institutions suggest incorporating patients and their views when developing CGs, little detail is provided on how to do this and institutions should provide more guidance.

52 citations


Authors

Showing all 2000 results

NameH-indexPapersCitations
Douglas G. Altman2531001680344
John P. A. Ioannidis1851311193612
Jasvinder A. Singh1762382223370
George A. Wells149941114256
Shah Ebrahim14673396807
Holger J. Schünemann141810113169
Paul G. Shekelle132601101639
Peter Tugwell129948125480
Jeremy M. Grimshaw123691115126
Peter Jüni12159399254
John J. McGrath120791124804
Arne Astrup11486668877
Mike Clarke1131037164328
Rachelle Buchbinder11261394973
Ian Roberts11271451933
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Performance
Metrics
No. of papers from the Institution in previous years
YearPapers
20231
202210
2021289
2020288
2019215
2018213