The Cochrane Library contribution to what we know: now and in the future David Tovey Editor in...
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Transcript of The Cochrane Library contribution to what we know: now and in the future David Tovey Editor in...
The Cochrane Library contribution to what we know: now and in the future
David ToveyEditor in Chief
The Cochrane Library: measuring contribution
• Coverage: growth and range of reviews• Impact• Quality• Timeliness• Applicability• Accessibility (presentation & delivery)
Together our achievements are remarkable:
• 4027 completed and 1906 ongoing systematic reviews
• Cochrane reviews represent 20% of all systematic reviews
• Cochrane reviews higher quality than non Cochrane reviews
Cochrane evidence used worldwide by wide range of stakeholders in diverse products and activities
Building social capital throughout the world
Substantive contribution to capacity building globally
Advancing the science of synthesis
Advocating for evidence informed decision making
Thanks to Jeremy Grimshaw
What’s the future?
Coverage
Coverage
But...
But...
What’s the future?
Consistent coverage
Commissioned reviews
Different databases alongside CDSR in The Cochrane Library?
What’s the future?
Diagnostic reviews
Overviews of reviews
Added value intervention reviews
Impact
19%
1 sec
2 sec
3 sec
Review Title Usage Count Rank World -full text accesses
Interventions for treating obesity in children 10,432 1
Interventions for preventing falls in older people living in the community
8,904 2
Interventions for preventing obesity in children 8,096 3
Interventions for preventing falls in elderly people 7,177 4
Exercise or exercise and diet for preventing type 2 diabetes mellitus
5,814 5
Midwife-led versus other models of care for childbearing women
5,201 6
School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6-18
5,192 7
Support surfaces for pressure ulcer prevention 5,071 8
Interventions for enhancing medication adherence 5,044 9
Nicotine replacement therapy for smoking cessation 4,549 10
ImpactReview Title Usage
CountRank World -full text accesses
Rank Canada
Interventions for preventing falls in older people living in the community
8,904 2 1
Interventions for treating obesity in children 10,432 1 2
Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes
3,748 24 3
Interprofessional education: effects on professional practice and health care outcomes
4,184 15 4
Interventions for preventing obesity in children 8,096 3 5
Vitamin C for preventing and treating the common cold 3,370 30 6
Echinacea for preventing and treating the common cold 2,017 132 7
Interventions for preventing falls in elderly people 7,177 4 8
Cranberries for preventing urinary tract infections 4,423 11 9
St John's wort for major depression 4,393 12 10
19%
1 sec
2 sec
3 sec
Impact
But....
“You could walk out on to the streets of Singapore now..”
What’s the future?
Better stakeholder engagement
Increasing usage
Prioritise high impact reviews
“..we observed far superior reporting standards of Cochrane reviews compared to non-Cochrane therapeutic ones.”
“For therapeutic reviews, all the Cochrane ones reported assessing the quality of included studies whereas only half of the non-Cochrane did (43/87 [49.4%]).”
“The seven industry supported reviews that had conclusions recommended the experimental drug without reservations, compared with none of the Cochrane reviews (P = 0.02), although the estimated treatment effect was similar on average (z = 0.46, P = 0.64).”
Quality
Quality• Coverage of harms
• Relevance
• Slavish adherence to arbitrary measures of statistical significance
• Absolute and relative risk
• Publication and outcome selection bias
• Non randomised studies
Absolute and relative effects
“If Cochrane reviews continue to express results solely in [relative] terms, they will continue to mislead clinicians, reporters, and the general public in just the way the pharmaceutical and vaccine companies would like.”
Maryann Napoli – personal communication
Publication Bias
What’s the future?
Agreed standards for process and review quality
“Fit for purpose” updating
Timeliness
Timeliness
Applicability
• > 50% “insufficient evidence”• 14% “empty”Results: Six empty reviews found no eligible randomised trials and six found one trial, precluding a systematic review; some empty reviews investigated irrelevant topics. Twenty-one reviews investigated outdated interventions, and thirteen of them were posted ten or more years after the publication of the most recent trial included. Most reviews were too lengthy (median: 40 pages) and their consultation was time-consuming with respect to clinical content.
What’s the future?
Crisply written, shorter reviews
More efficient review production
“Fast track” service?
Accessibility
Accessibility
Accessibility
Accessibility
What’s the future?
Better presentation & delivery
More interactivity
Integration and decision support
“Our duty to develop”
What’s the future?
Learn from others:
- Prioritise: focus on reader
- More input from stakeholders
- More transparency
What’s the future?
Strategic partnerships:
- Knowledge developers
- Commissioners
- Technology partners
What’s the future?
Wider participation:
- LMICs
- Health professionals in training?
-Consumers / carers?
5 year plan
• These are my targets for the next 5 years:– 90% of reviews “fit for purpose”– “Comprehensive” coverage of prioritised questions– 50% reduction in length of time taken from registration
to review publication– Impact factor 10+– 50% increase in “usage” / impact– 30% increase in “participation”– 20% reviews commissioned and/or funded
My questions to you
What is the single change we could make to The Cochrane Library that would make the most difference to getting evidence into practice?
What would your action plan be and how could we achieve it?
Thank you for listening