Evaluation & the health professions
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A fundamental aim of any systematic review is that all relevant studies should be identified and considered for inclusion. Limitations with searching bibliographic databases led the Cochrane Collaboration to search journals by hand for reports of trials. This article presents the results of a 3-year project to identify and make accessible reports of randomized trials published in European general health care journals. ⋯ Only 3,640 (17%) reports were indexed in MEDLINE as controlled trials, and 6,554 (30%) were not indexed in MEDLINE at all. Bibliographic details for all reports are available by searching The Cochrane Controlled Trials Register in The Cochrane Library. This project has ensured that a large proportion of trial reports not previously identifiable has been made accessible to those preparing systematic reviews.
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In 1998, the Cochrane Injuries Group published the results of a systematic review of human albumin administration in critically ill patients. The results showed that the risk of death in patients receiving albumin was 14%, and the risk of death in patients not receiving albumin was 8%, suggesting that for every 17 critically ill patients treated with albumin there is one extra death. The results were widely reported in the television and print media throughout the world and stimulated an immediate response from the drug regulatory agencies, the plasma products industry, and the medical profession. Despite vigorous attempts by the plasma products industry to limit the effect of the systematic review on albumin sales, the use of albumin declined steeply, showing that evidence from systematic reviews can have an important effect on clinical care.