The Cochrane Colloquium comes to India

Chowmahalla Palace,Hyderabad

Picture from Chowmahalla Palace,Hyderabad, royal seat of the Asaf Jahi dynasty where the Nizams entertained their official guests and royal visitors.

Cochrane, the global leader in evidence-informed health is for the first time in its more than 20 year history (the first Cochrane Centre opened in Oxford,UK in October 1992 ) is for the first time holding its annual colloquium in India, or for that matter in South Asia.

The 22nd Cochrane Colloquium takes place in Hyderabad, India from 21-26 September, 2014 with the theme ‘Evidence-informed public health: opportunities and challenges’. The event is landmark especially when seen in the background of the impending evidence based medicine as well as universal health coverage in South Asia.The event will see Professor Gordon Guyatt delivering the Annual Cochrane Lecture and plenaries conducted and chaired by global leaders on EBM,public health and policies with the following themes :
1. East meets West: Evidence-Informed Public Health; Concepts, Context, Opportunities, Challenges,
2.Public Health: the context, the vision, the opportunities
3.Capacity Development: Challenges and Innovations
4.Cochrane Reviews: Assuring Quality and Relevance
5.Advocating for Evidence: Improving Health Decision-Making through Advocacy, Partnerships and Better Communication

Five Special themed session which will highlight important issues on the following theme are also scnheduled and their are inumerable workshops held.There are about 88 oral presentations and more than hundred posters.

Keep looking at this page for daily on the spot  updates on the event.
Link: https://colloquium.cochrane.org/

Can quick answers be evidence informed?

Originally posted on Flying Evidence:

As a clinician or user of health services, you notice (sooner or later :)) that there are lots of uncertainties on the effectiveness of different interventions that you use or prescribe daily. I mentioned in a previous blog that this a huge problem in dentistry.

There are a number of initiatives which aim to fill these knowledge gaps by doing systematic reviews – finding all studies for a focused question (see Dominic’s blog on how a focus question is defined), judge how good they are and possibly synthesizing the data in those studies. They are brilliant and give you some guidance on what is known and what is still unknown on a specific topic area area. You can read summaries of some of these systematic reviews on a blog called Evidently Cochrane. However, sometimes it can be very frustrating when you have a very important question but you find…

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Society, Culture and Engaging with Evidence and Science

Originally posted on Flying Evidence:

In several occasions, I have been surprised on the perception of some researchers that any strategy and project that worked in their countries can be easily transferred and used in another one.  If one never lived in a country, it is very difficult to imagine what are the barriers and challenges that people (living there) face.

I recently peer reviewed a project report for someone on implementing some scientific projects in developing countries. It is a bit extreme (and in my view wrong) assumption that all developing countries are the same and can be treated as a group of similar countries. In addition to this,  most of the included studies in the report recommended to start the project with a situation analysis on burden of disease, other data in that country. In most of the developing countries that I have lived in (or know people who lived there), there are…

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SYSTEMATIC REVIEWS ON IMPLEMENTING GUIDELINES: WHY ARE THEY COMPLICATED? PART-2

Originally posted on Flying Evidence:

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If you have read my previous post on this topic, you know that I am involved in a systematic review with a complicated title “Local Consensus Process: Effects on professional practice and health care outcomes” (I know, I know, sounds complicated, you need to read the previous post to understand the topic). My review is one review among a number of reviews on implementing guidelines conducted by different author groups around the world in collaboration with the Effective Practice and Organisation Cochrane review group of the Cochrane Collaboration. So lots of clever people (FORTUNATELY!) have thought through some of the difficulties in conducting these types of reviews (before I got involved) and am following their methods. The methods are long and complex. I explained a little bit in the previous post but do like to talk about a part that I think is quite clever in this post.

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Health and beyond… strategies for a better India: Concept paper on primary health care in India

India is one of the fastest growing economies of the world, and is posed to overtake China in terms of being the most populous nation of the world. The very essential components of primary health care – promotion of food supply, proper nutrition, safe water and basic sanitation and provision for quality health information concerning the prevailing health problems – is largely ignored. Access to healthcare services, provision of essential medicines and scarcity of doctors are other bottlenecks in the primary health care scenario. Complete absence of evidence-based guidelines on clinical scenarios and treatment plans in the primary health care sector, together with overburdening of the secondary and tertiary care sectors, has substantially lowered the quality of care in the nation.
The paper by Dr. Soumyadeep B published in the Journal of Family Medicine and Primary Care , of the Academy of Family Physicians of India is a concept note that suggests a triad of strategies (technology, accountability and ink-blot strategy) that can be adapted to various problems in the primary healthcare scenario . Read the full paper here (Open Access ): http://www.jfmpc.com/text.asp?2014/3/2/94/137608

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What are the benefits and harms of different intravenous fluid regimens in people with acute bacterial meningitis?

Along with Dr Ian K Maconochie Department of Paediatrics A&E, St Mary’s Hospital, London, UK – Dr Soumyadeep Bhaumik has completed a Cochrane  systematic review and meta-analysis titled “Fluid therapy for acute bacterial meningites”.

The extensive review has data of 415 patients in total and “no significant differences in death rates or overall effects on neurological function, either immediately or later. There was also some evidence favouring maintenance fluid therapy over restricted fluids for chronic severe neurological events at three months follow-up.”Capture

However the available evidence is limited and not of high  quality (GRADE) and there is an immense need to conduct more research on the issue . It is indeed sad that trials on intravenous fluids for bacterial meningites,one of the most importance interventions are not happening. This is probably because unlike antibiotics from which “big and small pharma “can make huge profites – research on intravenous fluids is not profitable. There is a need for charities as well as government funding for sponsorinf trials on these kind of interventions.

Read full Cochrane Review here . (Click : Open access in India vide ICMR funding)

Read Cochrane Clinical Answer on this topic here . (Click : needs subscription)

About half of chronic pain research remains unreported

Results from more than half of clinical trials for common chronic pain disorders are not readily available on global registries, according to a new paper in the journal PAIN [1]. The survey included 15 major registries accessible through the World Health Organisation’s International Clinical Trials Registry Platform. Of the 447 unique trials identified, only 46% had results available. Dr Michael Rowbotham, Scientific Director of the California Pacific Medical Center Research Institute and lead study author:

Many patients enter clinical trials with the belief that by taking part in research, they will help other patients in the future. For that to happen, the results of this research must be transparent and fully available.

AllTrials co-founder Dr Ben Goldacre:

Once again we see that half of all trial results for currently used treatments are missing. While industry groups like the ABPI give false reassurance, and try to pretend that this problem has gone away, patients are being unnecessarily harmed. Industry, regulators, patient groups, professional bodies and the research community need to take action, show leadership, and address this problem urgently.

Capture The same is true for research on all domains. It’s time all clinical trial results are reported. Patients, researchers, pharmacists, doctors and regulators everywhere will benefit from publication of clinical trial results. Wherever you are in the world please sign the petition: Thousands of clinical trials have not reported their results; some have not even been registered. Information on what was done and what was found in these trials could be lost forever to doctors and researchers, leading to bad treatment decisions, missed opportunities for good medicine, and trials being repeated.   All trials past and present should be registered, and the full methods and the results reported. Join the AllTrials Campaing to call on governments, regulators and research bodies to implement measures to achieve this by signing the petition here.

[1] “RReACT Goes Global: Perils andPitfalls of Constructing a Global Open-Access Database of Registered Analgesic Clinical Trials and Trial Results,” by Troels Munch; Faustine L. Dufka; Kaitlin Greene; Shannon M. Smith; Robert H. Dworkin; Michael C. Rowbotham (DOI: http://dx.doi.org/10.1016/j.pain.2014.04.007). It appears online ahead of PAIN®, Volume 155, Issue 8 (August 2014) published by Elsevier.

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