Cochrane Reviews - Jas Daurka 16/10/2008

The Cochrane Collaboration is a group of over 11,500 volunteers in more than 90 countries who apply a rigorous, systematic process to review the effects of interventions tested in biomedical randomized controlled trials . A few more recent reviews have also studied the results of non-randomized, observational studies . The results of these systematic reviews are published in the Cochrane Library .

The Cochrane Collaboration was founded in 1993 under the leadership of Iain Chalmers , It was developed in response to Archie Cochrane 's call for up-to-date, systematic reviews of all relevant randomized controlled trials of health care. Cochrane's suggestion that the methods used to prepare and maintain reviews of controlled trials in pregnancy and childbirth should be applied more widely was taken up by the Research and Development Programme, initiated to support the United Kingdom 's National Health Service . Funds were provided to establish a ' Cochrane Centre ', to collaborate with others, in the UK and elsewhere, to facilitate systematic reviews of randomized controlled trials across all areas of health care. ^[2]

The goal is to help people make well informed decisions about health care by preparing, maintaining and ensuring the accessibility of systematic reviews of the effects of health care interventions. The principles of the Cochrane Collaboration:

collaboration
building on the enthusiasm of individuals
avoiding duplication
minimizing bias
keeping up to date
striving for relevance
promoting access
ensuring quality
continuity
enabling wide participation

Injuries group review of reviews as of October 2008

Title	RCTs	No of patients	Results	Notes
Anaesthesia for hip fracture surgery in adults	22	2567	Regional – less confusion and reduced DVT vs general	No real difference except DVT/confusion
Anaesthesia for treating distal radial fracture in adults	18	1200	Haematoma block poorer analgesia and reduction than regional(IVRA)	Haematoma block not great
Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures	22	8307	Single dose antibiotic prophylaxis significantly reduced deep wound infection,superficial wound infections, urinary infections, and respiratory tract infections multi dose has similar effects Economic modelling using data from one large trial indicates that single dose prophylaxis with ceftriaxone is a cost-effective intervention	Use ceftriaxone single dose
Antibiotics for preventing infection in open limb fractures	7	913	The use of antibiotics had a protective effect against early infection compared with no antibiotics or placebo There were insufficient data in the included studies to evaluate other outcomes	Use antibiotics
Arthroplasties (with and without bone cement) for proximal femoral fractures in adults	6unvs cem hemi) 7 bip vshm 5 (hemi vs thr)	549 857 608	Not enough evidence from randomised trials to show which arthroplasty is best There is some evidence that people with arthroplasties that are cemented in place may have less pain and better mobility after the operation than those, which are inserted as a press fit. No difference between uni and bipolar A trend to better functional outcomes after total hip replacement, but firm conclusions could not be made because of the lack of patient numbers.	Cemented hemis give less pain/better mobility No difference in uni/bipolar THR better functional outcomes
Autologous cartilage implantation for full thickness articular cartilage defects of the knee	4	266	no evidence of significant difference between ACI and other interventions. no statistically significant difference in outcomes at two years in a trial comparing ACI with microfracture. In addition, one trial of matrix-guided ACI versus microfracture did not contain enough long-term results to reach definitive conclusions.	No difference – stick with microfracture
Biopsychosocial rehabilitation for upper limb RSI	2		there appears to be little scientific evidence for the effectiveness of biopsychosocial rehabilitation on repetitive strain injuries	No evidence to support
Bioresorbable fixation devices for musculoskeletal injuries in adults	31		No significant difference between the bioresorbable and other implants could be demonstrated with respect to functional outcome, infections and other complications. Reoperation rates were lower in some of the groups of people treated with bioresorbable implants.	No difference except lower reop rates
Bone grafts and bone substitutes for treating distal radial fractures in adults	10	874	that while bone scaffolding may improve anatomical outcome compared with plaster cast immobilisation alone, there is insufficient evidence to conclude on function and safety; or on outcome for other comparisons.(vs ex fix)	Better anatomy – no difference in function
Closed reduction methods for treating distal radial fractures in adults	3	404	that there was not enough evidence to decide whether there was any difference between the various methods tested. Mechanical (finger trap)/manual/reduction device	No difference
Closed suction surgical wound drainage after orthopaedic surgery