The Cochrane Library contribution to what we know: now and in the future

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The Cochrane Library contribution to what we
know now and in the future

• David ToveyEditor in Chief

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The Cochrane Library measuring contribution

• Coverage growth and range of reviews
• Impact
• Quality
• Timeliness
• Applicability
• Accessibility (presentation delivery)

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Together our achievements are remarkable
Cochrane evidence used worldwide by wide range of
stakeholders in diverse products and activities

• 4027 completed and 1906 ongoing systematic
  reviews
• Cochrane reviews represent 20 of all systematic
  reviews
• Cochrane reviews higher quality than non Cochrane
  reviews

Advocating for evidence informed decision making
Advancing the science of synthesis
Substantive contribution to capacity building
globally
Building social capital throughout the world
Thanks to Jeremy Grimshaw
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Whats the future?
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Coverage
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Coverage
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But...
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But...
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Whats the future?
Consistent coverageCommissioned
reviews Different databases alongside CDSR in
The Cochrane Library?
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Whats the future?
Diagnostic reviews Overviews of reviews Added
value intervention reviews
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Impact
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
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Impact
Review Title Usage Count Rank 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
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Impact
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But....
You could walk out on to the streets of
Singapore now..
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Whats the future?
Better stakeholder engagement Increasing
usagePrioritise high impact reviews
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Quality
..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).
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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

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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
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Publication Bias
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Whats the future?
Agreed standards for process and review
quality Fit for purpose updating
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Timeliness
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Timeliness
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Applicability

• gt 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.
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Whats the future?
Crisply written, shorter reviews More efficient
review productionFast track service?
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Accessibility
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Accessibility
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Accessibility
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Accessibility
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Whats the future?
Better presentation deliveryMore
interactivity Integration and decision support
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Our duty to develop
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Whats the future?

• Learn from others
• - Prioritise focus on reader
• More input from stakeholders- More
  transparency

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Whats the future?
Strategic partnerships- Knowledge
developers- Commissioners- Technology partners
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Whats the future?

• Wider participation- LMICs- Health
  professionals in training?
• Consumers / carers?

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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

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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?

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Thank you for listeningdtovey_at_cochrane.org