Presentation on theme: "The Cochrane Library contribution to what we know: now and in the future David Tovey Editor in Chief."— Presentation transcript:
The Cochrane Library contribution to what we know: now and in the future David Tovey Editor 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?
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 TitleUsage CountRank World - full text accesses Interventions for treating obesity in children10,4321 Interventions for preventing falls in older people living in the community 8,9042 Interventions for preventing obesity in children8,0963 Interventions for preventing falls in elderly people7,1774 Exercise or exercise and diet for preventing type 2 diabetes mellitus 5,8145 Midwife-led versus other models of care for childbearing women5,2016 School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged ,1927 Support surfaces for pressure ulcer prevention5,0718 Interventions for enhancing medication adherence5,0449 Nicotine replacement therapy for smoking cessation4,54910
Impact Review TitleUsage CountRank World - full text accesses Rank Canada Interventions for preventing falls in older people living in the community 8,90421 Interventions for treating obesity in children10,43212 Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes 3, Interprofessional education: effects on professional practice and health care outcomes 4, Interventions for preventing obesity in children8,09635 Vitamin C for preventing and treating the common cold3, Echinacea for preventing and treating the common cold2, Interventions for preventing falls in elderly people7,17748 Cranberries for preventing urinary tract infections4, St John's wort for major depression4, % 1 sec 2 sec 3 sec
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
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
What’s the future? Agreed standards for process and review quality “Fit for purpose” updating
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?
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? 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?