An introduction to the Cochrane Collaboration & the Cochrane Skin Group

1. Finola Delamere,Managing Editor Cochrane Skin GroupCentre of Evidence Based Dermatology (CEBD)Nottingham, UK

2. An introduction to the Cochrane Collaboration & the Cochrane Skin Group

3. Rationale for Cochrane Collaboration • Collective ignorance about effects of healthcare • Overwhelming amount of clinical information • A systematic approach needed to organising and evaluating clinical trial data • The Cochrane systematic review

4. What is the Cochrane Collaboration? • An international organisation • It prepares and maintains the Cochrane Library which is published online • The principle source of up-to-date high quality evidence on the effects of healthcare interventions

5. Cochrane Centres Canadian Nordic German UK Dutch French Iberoamerican Italian Chinese US South Asian Brazilian South African Australasian

6. Cochrane Collaboration - structure Collaborative Review Groups Centres Steering Group Methods Groups Fields The Consumer Network

7. Why the ‘Cochrane’ Collaboration? • Archie Cochrane, a British epidemiologist, pointed out the deficiencies of current reviews of the medical literature in Cochrane AL (1972). 'Effectiveness and Efficiency: random reflections on health services'. • Iain Chalmers -an obstetrician in Cardiff,UK. The first ‘Cochrane Centre’ opened in Oxford 1992.

8. What makes a Cochrane review? • Structured process involving several steps • Well formulated question • Team effort • Comprehensive data search • Unbiased selection and abstraction process • Critical appraisal of data • Synthesis of data

9. Why is a Cochrane review different from any other review? • Rigorous, open, published research methods • More exhaustive search for trials than a conventional review • Two stages - protocol and full review - both peer reviewed • Highlights both implications for practice and for research • Only systematic review to be updated regularly.

10. Stages of a Cochrane Review • Submit a title-the idea • Write the protocol-the plan • Write the review-the product

11. Cochrane Skin Group • Currently we have published 48 reviews-which we aim to update every 2 years • Currently we have published 40 protocols- which are under development to reviews • Currently 20 registered titles under development to published protocols

12. Cochrane Skin GroupSome of the reviews & updated reviews we havepublished in The Cochrane Library in 2010 • Interventions for vitiligo (updated review) by Whitton ME, Pinart M, Batchelor J, Lushey C, Leonardi-Bee J, González U • Interventions for bullous pemphigoid (updated review) by Kirtschig G, Middleton P, Bennett C, Murrell DF, Wojnarowska F, Khumalo NP • Interventions for melasma (new review) by Rajaratnam R, Halpern J, Salim A, Emmett C • Interventions for cellulitis and erysipelas (new review) by Kilburn SA, Featherstone P, Higgins B, Brindle R

13. Cochrane Skin GroupSome of the protocols we have published in The Cochrane Library in 2010 • Specific allergen immunotherapy for the treatment of atopic eczema by Calderon MA, Boyle RJ, Nankervis H, García Núñez I, Williams HC, Durham S • Interventions for preventing and managing radiation-induced skin reactions in cancer patients by Chan R, Webster J, Battistutta D, Chung B, Brooks L • Topical interventions for genital lichen sclerosus by Chi C-C, Baldo M, Kirtschig G, Brackenbury F, Lewis F, Wojnarowska F

14. Cochrane Skin GroupSome of the reviews currently in the editorial process • Interventions for ingrowing toenails (U) • Interventions for impetigo (U) • Interventions for nail psoriasis (R) • Interventions for infantile haemangiomas (R) • Venom immunotherapy for preventing allergic reactions to insect stings (P) • Balneophototherapy for chronic plaque type psoriasis (P) • Interferon alpha for the adjuvant treatment of cutaneous melanoma (P) • Interventions for mycosis fungoides (P)

15. Impact of Skin Group reviews About half of our reviews make recommendations to help clinical practice by for example being used in guidelines: Interventions for vitiligo –Clinical Knowledge Summary Topical treatments for chronic plaque psoriasis – the subject of a publication to help clinicians put evidence into practice Interventions for American cutaneous and mucocutaneous leishmaniasis- 1st prize from Pan American Health Organisation for its relevance to a neglected disease in the Americas

16. Other skin reviews highlight research gaps: • Interventions for basal cell carcinoma – SINS trial (Surgery vs Imiquimod for Nodular & Superficial BCC) RCT of excisional surgery vs imiquimod 5% cream for nodular and superficial basal cell carcinoma (SINS) Patient 3 year follow up has been completed, analysis due to start on primary outcomes • Interventions for bullous pemphigoid – BLISTER trial (The Bullous Pemphigoid Steroids and Tetracyclines Study) RCT to compare the safety & effectiveness of doxycycline (200 mg/day) with prednisolone (0.5 mg/kg/day) for the initial treatment of bullous pemphigoid. 64 of 256 bullous pemphigoid participants currently recruited

17. Cochrane Skin Group www.skin.cochrane.org

19. How you can get involved • Read our reviews • Comment on published reviews via the feedback facility on the Cochrane Library • Be a peer referee for us • Become a Skin Group review author!

20. The Cochrane Librarywww.thecochranelibrary.org • Electronic publication published online • Issued monthly • Database called ‘Cochrane Reviews’ • Database called ‘Clinical Trials’

22. Rationale for Cochrane Collaboration • Collective ignorance about effects of healthcare • Overwhelming amount of clinical information • A systematic approach needed to organising and evaluating clinical trial data • The Cochrane systematic review