Mike Clarke speaking at the Symposium on the 10th Anniversary of the German Cochrane Centre

1. Systematic reviews and randomised trials: influencing public policy 2 April 2008 Professor Mike Clarke UK Cochrane Centre Clinical Trial Service Unit, University of Oxford School of Nursing and Midwifery, Trinity College Dublin

5. Example

7. International Sub-arachnoid haemorrhage trial ISAT

13. Death

16. Treatments for stroke: from suggestion through randomised trials to routine clinical practice 1920 1930 1940 1950 1960 1970 1980 1990 2000 Coiling ruptured aneurysms Cholesterol  - 2 0 prevention BP  - acute stroke BP  - 2 0 prevention Thrombolysis - acute stroke Warfarin in SR - 2 0 prevention Warfarin in AF - 2 0 prevention Heparin - acute stroke Neuroprotection - acute stroke Aspirin - acute stroke Thienopyridines - 2 0 prevention Dipyridamole + asp - 2 0 prevention Aspirin - 2 0 prevention Carotid angioplasty Carotid endarterectomy

17. Example

19. MidU Study

28. Systematic reviews

31. Overwhelming amount of healthcare literature

33. health

36. Example

39. Tamoxifen vs no tamoxifen, 1998

40. Avoiding undue emphasis on individual trials

41. How sure are we about this treatment?

42. How sure are we about this treatment?

43. Tamoxifen for 5 years (ER+), 2005 Breast cancer death Recurrence

48. What resources are available to help?

54. Implications for Practice (2006) 84 (3%) Only use in research 1409 (50%) Uncertain 206 (7%) Intervention doesn’t work 1305 (47%) Intervention works 2801 All Cochrane reviews

55. Implications for Research (2005) 82 (3%) No more research 1315 (52%) Types of outcome 765 (30%) Types of participant 2079 (82%) Types of intervention 2535 All Cochrane reviews