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

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).

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

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  1. The Cochrane Library contribution to what we know: now and in the future David ToveyEditor in Chief

  2. The Cochrane Library: measuring contribution • Coverage: growth and range of reviews • Impact • Quality • Timeliness • Applicability • Accessibility (presentation & delivery)

  3. 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 Advocatingfor evidence informed decision making Advancingthe science of synthesis Substantive contribution to capacity building globally Building social capital throughout the world Thanks to Jeremy Grimshaw

  4. What’s the future?

  5. Coverage

  6. Coverage

  7. But...

  8. But...

  9. What’s the future? Consistent coverageCommissioned reviews Different databases alongside CDSR in The Cochrane Library?

  10. What’s the future? Diagnostic reviews Overviews of reviews Added value intervention reviews

  11. Impact 19% 1 sec 2 sec 3 sec

  12. Impact 19% 1 sec 2 sec 3 sec

  13. Impact

  14. But.... “You could walk out on to the streets of Singapore now..”

  15. What’s the future? Better stakeholder engagement Increasing usagePrioritise high impact reviews

  16. 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 reviewsthat had conclusions recommended the experimental drug withoutreservations, compared with none of the Cochrane reviews (P= 0.02), although the estimated treatment effect was similaron average (z = 0.46, P = 0.64).”

  17. 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

  18. 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

  19. Publication Bias

  20. What’s the future? Agreed standards for process and review quality “Fit for purpose” updating

  21. Timeliness

  22. Timeliness

  23. 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.

  24. What’s the future? Crisply written, shorter reviews More efficient review production“Fast track” service?

  25. Accessibility

  26. Accessibility

  27. Accessibility

  28. Accessibility

  29. What’s the future? Better presentation & deliveryMore interactivity Integration and decision support

  30. “Our duty to develop”

  31. What’s the future? • Learn from others: • - Prioritise: focus on reader • More input from stakeholders- More transparency

  32. What’s the future? Strategic partnerships:- Knowledge developers- Commissioners- Technology partners

  33. What’s the future? • Wider participation:- LMICs- Health professionals in training? • Consumers / carers?

  34. 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

  35. 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?

  36. Thank you for listeningdtovey@cochrane.org

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