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Password Changed Successfully Your password has been changed. We offer seven themed study days. Aimed at registered nurses or allied healthcare professionals who wish to extend and consolidate their clinical knowledge in the field of dermatology nursing. This year the course will cover important clinical challenges in atopic dermatitis, urticaria and contact allergy in both adults and children.
Register early to avoid disappointment. Each year in the UK, 13 million individuals see their GP with a skin problem, and 5. Ultimately, we believe that by inspiring and educating healthcare providers, we will improve dermatology care for patients in the UK and beyond. Industry support has no influence on the educational content of our courses. Our aim is to promote dermatology education in the UK, by providing patient-centred, clinically-focused, evidence based dermatology education. Sponsors Sanofi Genzyme logo. Thus, mutilating operations such as 10 cm excision margins for primary cutaneous melanoma and radical vulvectomy for lichen sclerosus are now things of the past, yet they were practiced for decades by our predecessors on the basis of anecdote and case reports and a failure to question the rationale for the treatments we use.
We must all get involved in making sense of how to best treat patients and we should not be afraid of challenging current practices and changing our practice in light of new knowledge, regardless of how experienced we become. Our work at the Centre of Evidence-Based Dermatology can be considered as three consecutive processes: systematic reviews to summarise what is known, clinical trials to address knowledge gaps, and finally knowledge management and dissemination. Even though randomised controlled trials offer the best study design to minimise the risk of bias when evaluating the efficacy of a new treatment, one RCT is rarely enough for three reasons.
The first is that a positive result could have simply arisen through chance. Therefore, with around over 17, trials relevant to skin already published, there will be a lot of studies out there that claim an effect when the results are really due to the play of chance. That is why the Food and Drug Administration FDA requires two identical trials to be conducted for licensing purposes for a new drug in order to reduce the chances of a single false positive result.
The tendency to selectively publish positive studies publication bias means that the results of single trials, even when large and published in prestigious journals, are frequently contradicted when the totality of subsequent evidence is considered. The second reason why one RCT is not enough is because it is sometimes difficult to generalise from the people included in just one study. For example, a clinical trial of calcipotriol in a group of older men with plaque psoriasis living in Wales may contain a study population that is too different to inform treatment choices facing young women presenting with guttate psoriasis in Kolkata.
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A more generalisable answer about an intervention may be achieved by considering several studies that have been assembled together that include different populations, different ages, cultural beliefs, and co-morbidities. The final reason of why one RCT is never enough is that despite efforts to minimise bias, RCTs can be reported in misleading ways that can be influenced by hidden motives such as making profit for a company or for promoting individuals.
Systematic reviews mitigate against such framing bias by drawing attention to possible conflicts of interest and by pointing out what was not said in the trial report as well as what was highlighted. A major part of systematic reviews is to draw attention to the quality of reporting of trials, and whether the outcomes were analysed in the way they were meant to be analysed. It is only by putting all relevant information together that we are best able to make sense of a particular intervention.
Even if the conclusion of such a systematic review is simply to state that no reliable evidence has been produced to date to guide practice and that the best way forward is to start conducting well designed trials, it is a start in the right direction. Traditional expert reviews might sound appealing, but they frequently fail to mention important studies and they may be prone to selective citation to support the expert's prejudice simply because they have not been done in a systematic and explicit way.
It was the failure of the medical profession to systematically collate evidence from high quality randomised controlled trials that prompted the late Professor Archie Cochrane to challenge doctors to do something about it in the s. The International Cochrane Collaboration was formed 25 years later in response to this challenge. The Cochrane Collaboration is a non-profit organisation of individuals that now contains over 50 review groups covering all aspects of human medicine.
The Cochrane Skin Group [ Figure 4 ] is one such group that was formed in and is supported by an editorial base at our Centre of Evidence-Based Dermatology in Nottingham.
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The editorial base comprises a review group coordinator, an editorial assistant, a trials search co-ordinator, and a co-ordinating editor the author. Our job is to prioritise and support high-quality systematic reviews of interventions to prevent or treat skin diseases using the methods developed by the Cochrane Collaboration. So far, the Skin Group has published 39 full reviews and a similar number of published protocols that will eventually become full reviews. Some reviews relevant to dermatology are produced by other groups such as the Wounds, Pregnancy and Childbirth or Infectious Diseases Groups so that there are now over reviews published on the Cochrane Library relevant to dermatology.
Some have criticised Cochrane reviews for always concluding that there is insufficient evidence to recommend anything. Not only do they deal with common conditions such as acne, psoriasis, and eczema, which affect all of the world's populations, but they also cover diseases that occur in developing countries such as cutaneous leishmaniasis, leprosy, and tropical ulcers. Venereal diseases are dealt with by the relatively newly formed Cochrane Sexually Transmitted Diseases group. Unlike other publications that quickly become out of date, Cochrane reviews are updated periodically as new evidence becomes available.
Anybody can get involved in preparing and maintaining reviews but the work is hard and a degree of training and experience is needed before somebody leads a new review team. At the very least, anyone can read Cochrane reviews and use the evidence to inform daily practice. Cochrane reviews are published every quarter in an online product called the Cochrane Library , which also contains the largest database of clinical trials in the world and other useful methodological resources.
And here is the most fascinating thing about the whole endeavour: During one of my talks at the 36 th National Conference of the Indian Association of Dermatologists, I asked members of the audience about the Cochrane Library. Several had heard of it but none claimed to have access to it. Yet 10 minutes before that lecture, I tried accessing the Cochrane Library from a terminal at the meeting by typing in www. So there is no excuse for not at least looking at Cochrane reviews because the Indian Government has made it possible to gain full and free access from any computer with an internet connection in India.
The Cochrane Skin Group logo shows five hands representing the five continents of the world joined together in the pursuit of the truth about skin disease treatments. Sometimes, Cochrane systematic reviews come up with clear clinical messages on what should or should not be used in clinical practice e. Such a finding is quite helpful for the clinician, in that it at least reassures us that we are not missing some new important finding about treatments that we should be using in practice.
It is also helpful to produce reviews that find insufficient evidence as it helps to draw a line in the sand that indicates a desperate need for a decent quality randomized controlled trial to address that area. The review can also suggest some priority to the questions that can be addressed by subsequent trials. Such is our philosophy at the Centre of Evidence-Based Dermatology — use systematic review to inform the need for clinical trials, which are then run by the UK Dermatology Clinical Trials Network after gaining suitable funding in open national competition from State funding bodies such as the National Institute for Health Research Health Technology Assessment Programme.
It involves a collaborative network of dermatologists, dermatology nurses, health services researchers, and patients throughout the UK and Southern Ireland. The Network is completely independent of the pharmaceutical industry. This should not be taken as meaning that the Network is against industry studies, but simply that dermatologists in the UK wanted to study questions that industry would never fund.
These include trials of orphan skin diseases like pyoderma gangrenosum or studies of non-pharmacological interventions such as water softeners for childhood eczema or studies of low cost generic treatments like tetracyclines versus oral prednisolone for bullous pemphigoid — all funded studies that are currently being run through the UKDCTN. The UKDCTN is a registered charity that is run by a network manager, senior trials manager, and an administrative assistant.
The organization is very democratic and accepts suggestions for new trials from all of its members. Those are then prioritized by a panel and developed into pilot studies and full funding applications. The UKDCTN took some time to get off the ground because it invested time in getting its structures and processes right, and now it is running five national studies [ Table 1 ].
The UKDCTN is highly interdisciplinary and it works closely with statisticians, health economists, and those with experience of running and reporting trials to Good Clinical Practice standards in collaboration with the Nottingham Clinical Trials Unit. The five national clinical trials currently being run at the centre of evidence-based dermatology. Much of the philosophy and processes for setting up and running an organization like the UKDCTN could be replicated in India, and in time, there will opportunities for such similar organizations to take part in collaborative studies that require very large numbers of patients from all over the world.
Producing lots of information is of little use unless it is filtered, organised, and made available for those working in clinical practice. Such is the purpose of the National Library of Health Skin Disorders Specialist Library — a one stop shop of quality information resources all in one place and kept up-to-date on a daily basis by a full-time information scientist based at our Centre of Evidence-Based Dermatology.
The information resources included in the Skin Disorders Library are quality appraised to avoid biased information. The resources are organised into guidance and pathways, evidence sources, reference articles, education and continual professional development, and patient information resources. Special features include guest editorials, an opportunity to submit uncertainties that require research to the Database of Uncertainties of the Effects of Treatments DUETs ,[ 14 ] and the annual evidence updates.
The annual evidence updates deserve a special mention since they go beyond just organisation of information. Each year, the four topics of acne, skin cancer, eczema, and psoriasis are searched in detail by our information specialist for newly published systematic reviews or trials. The new resources are then listed according to whether they deal with causes, treatment type, or effects on quality of life.