The past, the present and the future

The last day of the Cochrane Colloquium kicked off with the first annual Cochrane lecture, delivered by Sir Iain Chalmers via videoconference. He showed a film he recently made with Mark Starr demonstrating the Oxford Database of Perinatal Trials (ODPT – 1988-1993) and The Cochrane Collaboration Pregnancy and Childbirth Database (CCPC – 1993-1995), both of which were developed to provide the means for keeping systematic reviews up to date, and which the vast majority of people involved in The Cochrane Collaboration will never have heard of. These two publications were the predecessors of the Cochrane Database of Systematic Reviews. This short flim gave us some insight into the origins of the Cochrane Library and was really interesting.

During his discussion Sir Chalmers also emphasized the need to meet the continuing challenge of keeping reviews up to date. Currently, about 75 trials and 11 systematic reviews are being published on a daily basis! Not only does this pose a challenge to anyone who wants to keep abreast of the newest developments in health care, but also to the Cochrane Collaboration and the various editorial groups that are attempting to keep systematic reviews up to date.

By referring to a recent article published in PLoS Medicine (Bastian H et al. 2010: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000326), Sir Chalmers made the following suggestions for overcoming this challenge:

1. We need to reduce avoidable waste. This includes putting new RCT’s in the context of existing systematic reviews, therefore only conducting new trials if additional evidence is necessary. The same applies to systematic reviews.

2. We need to prioritise the questions that need to be addressed by considering the needs of policy makers, clinicians and patients, and by identifying the gaps in clinical guidelines.

3. We need streamlining and innovative methods to increase efficiency without comprimising the quality of the reviews. Some advances towards the standardisation of rapid reviews and the automation of systematic reviews have been made in this regard – although it is imperative to note that humans are the essential ingredient of systematic reviews and that cutting corners has the potential to introduce bias.

4. We need international collaboration among research funders. This could result in better use of available resources, as well as avoid duplication (=waste) of efforts.

5. We need systematic reviews to be available to clinicians, patients and policy-makers. This means having access to these on an open-access platform, so that they have the information they need to make important healthcare decisions.

After five days of interesting presentations, workshops, conversations and sharing of innovative ideas, it is evident that the future of the Cochrane Collaboration is filled with exciting opportunities, fascinating developments and enthusiastic contributors.

Here is to the next 20 years!

Chateau Frontenac

Chateau Frontenac

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Rapid reviews: finding the sweet spot

The need for timely evidence is one of the realities that need consideration in evidence-informed decisionmaking. Decisionmakers often need evidence yesterday.  However, conducting a rigorous systematic review can take, depending on the question and the available trials, 1 to 3 years.  This has created a need for rapid reviews.  Generally rapid reviews are regarded as an accelerated response (from 24 hours to 16 weeks), but there is currently no universal accepted definition or methodology. The concepts and challenges related to rapid reviews were explored today at a session at the Cochrane Colloquium.  Key themes were:

  • Rapid reviews may not be feasible in all circumstances
  • A one size fits all approach is not necessarily realistic
  • At which stage(s) should the process be accelerated?

In the presentations, rapid reviews varied from being:

  • Compiling a rapid review documenting existing evidence from systematic reviews
  • A rapid update of an existing outdated systematic review
  • Conducting a systematic review using accelerated methods (short cuts)

Through the Cochrane Innovations Company, a procedure manual for the preparation of Cochrane Response Rapid Reviews is currently being drafted.  This manual consists of 11 stages for conducting such a Cochrane Response.

Let’s watch the space for future developments.

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The user’s perspective

How can Cochrane reviews impact or communicate to relevant users? The rigourous methodology employed in preparing Cochrane reviews will not be of any use if the information does not reach or impact relevant users. In today’s plenary session various speakers including our own Professor Jimmy Volmink discussed how Cochrane reviews can better impact health policy makers, educators, health care professionals and patients. To impact policy or health system managers for example, a call was made to prepare more reviews on health system issues and those that are relevant to current policy needs.

Evidenced based health care has witnessed significant strides in Low and Middle Income countries (LMICs) but there is still a lot of work to be done. This was the take home message from the special session held today about boosting the production of evidence from LMICs. For instance, though there is an upward trend in the number of Cochrane review authors from the African region, more awareness and capacity buliding is needed.

This year’s colloquium also marked the first meeting of the The African Cochrane network. This meeting was attended by African authors from East, West and Southern Africa. Strategies were discussed on how the production of Cochrane reviews can be increased in the African region including Northern and Central Africa; areas that are not yet active in preparing reviews.

Finally, one of our researchers, Dr. Charles Okwundu received ” The Kenneth Warren Prize” for work on his Cochrane review ” Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals”. This prize is awarded annually to a primary author who is a national living in a developing country, of a review judged to be both of high methodological quality and relevant to health problems in poor countries. Congratulations Charles!!

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Navigating through the maze of evidence-informed policymaking

What are the implications and challenges of evidence-informed policymaking? This was explored in a session investigating international approaches related to the use of research evidence in policymaking. The following themes were unpacked:

  •  Assessment of policymakers’ capacity for evidence-informed decision-making
  • Translation of Cochrane abstracts and plain language summaries for use by decision makers
  • Development of user-friendly evidence-summaries by policymakers for essential medicine lists in the Americas

In this session, barriers and facilitators of using research evidence in policymaking were shared. Strategies to enhance the use of research evidence include strong relationships between policymakers and researchers and systematic review evidence that is well-packaged and summarised in not more than one page. The importance of joint efforts between researchers and policymakers was emphasised.

An interesting, pragmatic and simplified methodology was developed by the Iberoamerican Cochrane Centre and collaborators for formulating user-friendly evidence summaries that provide technical support to policymakers in the decision-making process.  This methodology includes the use of GRADE for considering quality of evidence, as well as comments on relevant economic studies and a contextualisation of applicability of the evidence.

Even though we need to learn a lot more about how to promote and establish evidence-informed policymaking, particularly in low and middle income countries, there is a good foundation on which we can build a bridge between the research evidence and policymaking for effective and efficient health care.

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Bienvenue à Quebec

This year’s Cochrane Colloquium is being held in Quebec City, Canada, situated on the shores of the St. Lawrence river, one of the largest rivers of the world. Founded in 1608, this old city is rich in history and an apt home for this year’s Colloquium: Better knowledge for better health – Un meilleur savoir pour une meilleure santé.

Today was all about registration and Cochrane business meetings, as well as the traditional newcomers’ session. We are looking forward to the welcome reception to be held at the magnificant Musée de la Civilisation.

Tomorrow kicks off with the opening ceremony and the first plenary: Better knowledge for better heath: effectiveness and Efficiency. the learning objectives for this plenary are:

1. Recognize the role of evidence to support health care decision-making.
2. Acquire an understanding of the history of The Cochrane Collaboration
and its contribution to evidence-based decisions in health care.
3. Identify future opportunities for The Cochrane Collaboration to support
evidence informed health care and health systems.

Follow our blog for daily highlights of this important event within the realm of evidence-informed health care.

The Joan of Arc park in Quebec City

The Joan of Arc park in Quebec City

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