Poor countries lack relevant health information, says Cochrane editor
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《英国医生杂志》
Although access to health information in developing countries has steadily improved over the past decade its local relevance is limited because most it is generated in developed countries. This was the key message froma seminar held last week in London by the Health Information Forum, a group set up to improve access to health information for developing countries. The meeting was organised by The International Network for the Availability of Scientific Publications.
One important example of the deficit in relevant information for those working in developed countries is in access to systematic reviews, said Paul Chinnock, managing editor of the Cochrane Injuries Review.
"Systematic reviews of research evidence play a central role in evidence-based medicine but few address topics that are a priority for the developing world," he said. "For example, surgeons in Africa would probably list umbilical hernia, gunshot wounds, sigmoid volvulus, and gangrene among the most common conditions in their practice. But no interventions for these have been covered by Cochrane reviews. Similarly, ketamine is the mainstay of anaesthesia in many poor countries but this has not been the subject of a systematic review."
Even where reviews are nominally relevant, he and other speakers emphasised, the treatment and interventions advocated are usually based on those used in rich countries and these may be unavailable or inappropriate in low income countries, where patients tended to present later and with co-existing disease.
Strategies for increasing the number of relevant systematic reviews, he suggested, include asking health professionals in developing countries to identify priority topics on which reviews should be conductedand basing reviews solely on research conducted in low income countries. Another approach would be to carry out subgroup analyses to distinguish between conclusions which stem from work conducted in developing countries and those from work conducted in developed countries.
Ongoing discussion of how to improve the flow of useful information to health professionals in developing countries will be conducted through the global e mail forum HIF-net. To join send your name, organisation and professional interests to health@inasp.info(London Tessa Richards)
One important example of the deficit in relevant information for those working in developed countries is in access to systematic reviews, said Paul Chinnock, managing editor of the Cochrane Injuries Review.
"Systematic reviews of research evidence play a central role in evidence-based medicine but few address topics that are a priority for the developing world," he said. "For example, surgeons in Africa would probably list umbilical hernia, gunshot wounds, sigmoid volvulus, and gangrene among the most common conditions in their practice. But no interventions for these have been covered by Cochrane reviews. Similarly, ketamine is the mainstay of anaesthesia in many poor countries but this has not been the subject of a systematic review."
Even where reviews are nominally relevant, he and other speakers emphasised, the treatment and interventions advocated are usually based on those used in rich countries and these may be unavailable or inappropriate in low income countries, where patients tended to present later and with co-existing disease.
Strategies for increasing the number of relevant systematic reviews, he suggested, include asking health professionals in developing countries to identify priority topics on which reviews should be conductedand basing reviews solely on research conducted in low income countries. Another approach would be to carry out subgroup analyses to distinguish between conclusions which stem from work conducted in developing countries and those from work conducted in developed countries.
Ongoing discussion of how to improve the flow of useful information to health professionals in developing countries will be conducted through the global e mail forum HIF-net. To join send your name, organisation and professional interests to health@inasp.info(London Tessa Richards)