Jonathan Biglietto, Bernard Kabuth, Étienne Kimmel, Jane-Laure Danan
[From nursing to changing social representations: the study of health literacy in psychiatry]
Soins; la revue de reference infirmiere
cochrane neonatal first established 1993 one original review groups cochrane collaboration fact origins cochrane neonatal precede establishment collaboration 1980s national perinatal epidemiology unit oxford led dr iain chalmers established oxford database perinatal trials odpt register virtually randomized controlled trials perinatal medicine provide resource reviews safety efficacy interventions used perinatal care foster cooperative coordinated research efforts perinatal field 1 effort clearly ahead time odpt comprised four main elements register published reports trials register unpublished trials register ongoing planned trials data derived pooled overviews metaanalyses trials core effort grew creation seminal books effective care pregnancy childbirth well effective care newborn infant 23 efforts perinatal medicine grew iain chalmers thought well beyond perinatal medicine creation worldwide collaboration became cochrane 4 mission cochrane collaboration promote evidenceinformed health decisionmaking producing highquality relevant accessible systematic reviews synthesized research evidence wwwcochraneorg cochrane neonatal continued one productive review groups publishing 25 tpo 40 new updated systematic reviews year impact factor steadily increasing four years rivals elite journals pediatric medicine cochrane neonatal worldwide effort currently 404 reviews involving 1206 authors 52 countries cochrane done babies reviews cochrane neonatal informed guidelines recommendations worldwide january 2018 june 2020 77 international guidelines cited 221 cochrane neonatal reviews recommendations included recommendations use postnatal steroids inhaled nitric oxide feeding guidelines preterm infants core aspects neonatal practice addition cochrane reviews impetus important research including largescale trial prophylactic indomethacin therapy variety trials postnatal steroids trials emollient ointment probiotic trials 6 justifiably proud accomplishments one needs examine future contribution cochrane neonatal neonatal community future cochrane neonatal inexorably linked future neonatal research obviously synthesis trials data community fail provide core substrate research look current trials environment fewer randomized controlled trial related neonates published recent years simple search pubmed limiting search neonates randomized controlled trials shows year 2000 321 randomized controlled trials published peaked five years ago 2015 close 900 trials published however 2018 791 studies identified decrease represent meaningful change neonatal research environment quite possibly shifting missions clinical neonatology academic medical institutions least united states focus business aspects well important competing clinical activities quality improvement taken one major activities private academic neonatal practices clearly needed improvement units levels need dedicated improving outcomes sick fragile population care however need expense formal clinical trials understandable approach would taken newer interventions frequently relate complex systems care simple single interventions even trials might traditionally done randomized controlled trials introduction new mode ventilation reality complex challenges ability institutions create systems adapt new technologies cost trials always barrier challenging regulatory ethical environment contributes problems well 7 despite barriers research agenda neonatal community move forward 21st century need reassess create disseminate research findings innovative trial designs allow us address complex issues may tackled conventional trials adaptive designs may allow us look potentially lifesaving therapies way feel efficient ethical 8 clarifying issues use inhaled nitric oxide preterm infants would greatly served even knew whether hypoxemic preterm infant would benefit therapy 9 current trials suggest yet current practice tells us significant number babies receive inhaled nitric oxide 1013 adaptive design done trials extracorporeal membrane oxygenation ecmo would allow us quickly assess whether fact therapies lifesaving allow us consider whether trials needed 1415 understanding many interventions involve entire systems approaches relegate us quality improvement work cluster designs may allow us test complex interventions usually purview quality improvement 1618 cluster trials well suited investigations done least interruption ongoing care ultimately quality improvement application best evidence available evidencebased medicine evidencebased practice 1920 nascent efforts statement embedding necessary research culture health enrich statement call conduct large efficient pragmatic trials evaluate neonatal outcomes part called alpha collaboration 2122 statement envisions international system identify important research questions consulting regularly stakeholders including patients public health professionals researchers providers policy makers regulators funders industry enrich statement envisions pathway enable individuals educational institutions hospitals healthcare facilities confirm status researchfriendly integrating understanding trials research critical thinking teaching learning culture well engagement funders professional organizations regulatory bodies stake holders raise awareness value efficient international research reduce barriers large international pragmatic trials collaborative studies future trials done scale trials prospectively designed analyzed together core outcome measures must identified standardized clinical trials supply estimates outcomes relevant patients families critical addition current neonatal research evaluates many different outcomes using multiple measures given measure multiple widely used definitions bronchopulmonary dysplasia chronic lung disease add confusion quickly comes mind 2324 use multiple definitions attempting measure outcome prevents synthesis trial results metaanalysis hinders efforts refine estimates effects towards end webbe colleagues set develop core outcome set neonatal research 25 key stakeholders neonatal community reviewed multiple outcomes reported neonatal trials qualitative studies based consensus key outcome measures identified including survival sepsis necrotizing enterocolitis brain injury imaging retinopathy prematurity gross motor ability general cognitive ability quality life adverse events visual impairment blindness hearing impairment deafness chronic lung diseasebronchopulmonary dysplasia trials registration continued focus neonatal community trials registration allows systematic reviewers understand whether reporting bias occurred 26 also allows transparent incorporation core outcome measures ultimately trials registration include public reporting core outcomes future access data individual level sophisticated individual patient data metaanalysis could occur lastly reason see clinical trials quality improvement separate exclusive activities fact first nicq collaborative conducted vermont oxford network participation trial postnatal steroids considered part quality improvement best practices opposed simply choosing asofyet unproven approach use potent drug 27 role cochrane neonatal play move forward 21st century neonatal community moves forward research agenda cochrane neonatal must follow also lead innovative approaches synthesizing research findings cochrane neonatal must continue work closely guideline developers relationship systematic review production guideline development clearly outlined reports institute medicine 2829 essential guideline development systematic review group culling evidence benefits harms given intervention guideline group addressing contextual issues cost feasibility implementation values preferences individuals societies national international guidelines groups routinely use systematic reviews evidence basis guidelines recommendations examples partnership cochrane neonatal international guideline development seen support world health organization guidelines use vitamin soon published recommendations international liaison committee resuscitation ilcor cord management preterm term infants 30 future need collaborate early guideline development process reviews fit purpose meet needs guideline developers end users towards end cochrane neonatal reviews contain grade assessments key clinical findings reported systematic review 31 addition assessments addresses critical issue confidence findings confident evidence provided randomized controlled trials assessment downgraded studies reported outcome question high risk bias indirectness inconsistency results imprecision evidence reporting bias information provided grade assessments seen critical process moving evidence formal recommendations 32 need explore complex reviews network nma multiple treatment comparison mct metaanalyses address issues formally addressed clinical trials 33 conditions multiple effective interventions rare possible interventions tested 34 solution could provided network metaanalysis allows comparing treatments even randomized controlled trials available treatment comparisons 34 network metaanalysis uses direct headtohead randomized clinical trial rct evidence well indirect evidence rcts compare relative effectiveness included interventions 35 however mills colleagues note methodological quality mtcs may difficult clinicians interpret number interventions evaluated may large methodological approaches may complex 35 cochrane neonatal must take role creation analyses education neonatal community regarding pitfalls approach availability individual patient data make sophisticated analyses available community although current crop individual patient data metaanalyses including reviews elective high frequency ventilation inhaled nitric oxide oxygen targets differed substantially findings trials level reviews suggesting fact sick neonates alike unalike still large role individual patient data metaanalysis least end unfound conclusions therapies effective various subgroups issues sex disease severity clinical setting 3639 future trials take lesson neoprom collaborative 3739 given difficulty generating significant sample size creating funding single environment trials similar protocols conducted variety healthcare settings eye towards study level individual patient level metaanalysis conclusion trials allowing broader contribution trials data rapid accrual sample size precise results need educate neonatal community regarding use abuse diagnostic tests diagnostic tests critical component healthcare also contribute greatly cost medical care worldwide costs include cost tests costs misdiagnosis treatment individuals benefit treatments clinicians may limited understanding diagnostic test accuracy ability diagnostic test distinguish patients without disease target condition 4142 efforts choosing wisely tried identify deficiencies 40 cochrane increased general literacy medical general population regarding interpretation results interventions various diseases cochrane move forward improve understanding diagnostic testing need become efficient creating maintaining reviews time spent produce systematic reviews far great average takes 2 6 years produce systematic review requiring intense time input highly trained expensive experts innovations ways produce systematic reviews make review process efficient outsourcing tasks crowdsourcing machine learning need let crowd machine learning innovations help us sort massive amounts information needed conduct systematic reviews also allow live updating critical reviews research landscape quickly changing 43 lastly cochrane neonatal must focus users reviews necessarily authors reviews current cochrane programming speaks cochrane training eye towards developing skills individuals conduct systematic reviews clearly needed laudable fact matter community users reviews individuals need understand use interpret findings systematic reviews review users include clinicians guideline developers policy makers families incorporation grade guidelines huge step adding transparency level uncertainty findings familys perspective need overcome environment mistrust misunderstanding scientific evidence convey know uncertainty know parents families