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%

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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

dtovey@cochrane.org