The Cochrane Collaboration and Evidence for Better Health

Dr David Tovey FRCGPEditor in Chief

The Cochrane Library

Knowledge is important!

“There had been reports that Chloe was not given the anti-viral drug Tamiflu after her doctor misdiagnosed her illness as tonsillitis......”

“There had been reports that Chloe was not given the anti-viral drug Tamiflu after her doctor misdiagnosed her illness as tonsillitis......”

“Between 1999 and 2002 Roche sold just 5.5 million treatments. Next year the total sales of oseltamivir are projected at 150 million. Roche's share price has soared this year by 60%.1 ”

1 BMJ 2005;331:1277 (26 November), doi:10.1136/bmj.331.7527.1277

“There had been reports that Chloe was not given the anti-viral drug Tamiflu after her doctor misdiagnosed her illness as tonsillitis......”

“Between 1999 and 2002 Roche sold just 5.5 million treatments. Next year the total sales of oseltamivir are projected at 150 million. Roche's share price has soared this year by 60%.1”

1 BMJ 2005;331:1277 (26 November), doi:10.1136/bmj.331.7527.1277

BMJ editor Dr. Fiona Godlee, said "claims that oseltamivir reduces complications have been a key justification for promoting the drug's widespread use. Governments around the world have spent billions of pounds on a drug that the scientific community has found itself unable to judge.“

Does it matter?

Does it matter?

Archie Cochrane

“It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials.”

Mission

• The Cochrane Collaboration is an international organisation that aims to help people make well-informed decisions about health care by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions.

Cochrane Principles

• Keeping up to date• Striving for relevance• Promoting access• Ensuring quality• Continuity

• Collaboration• Building on the enthusiasm

of individuals• Avoiding duplication• Minimising bias

Cochrane Principles

• Keeping up to date• Striving for relevance• Promoting access• Ensuring quality• Continuity

• Collaboration• Building on the enthusiasm

of individuals• Avoiding duplication• Minimising bias

Cochrane Principles

• Keeping up to date• Striving for relevance• Promoting access• Ensuring quality• Continuity

• Collaboration• Building on the

enthusiasm of individuals• Avoiding duplication• Minimising bias

Cochrane Principles

• Keeping up to date• Striving for relevance• Promoting access• Ensuring quality• Continuity

• Collaboration• Building on the enthusiasm

of individuals• Avoiding duplication• Minimising bias

The Cochrane Collaboration: a success story........

• 18,000 active volunteers• 1.2m website hits/month and > 1000 recorded

media hits for a single issue• >4000 systematic reviews plus access to

summaries of thousands more?

Cochrane geographical spread

Cochrane Review GroupsAcute Respiratory Infections Group Airways Group Anaesthesia Group Back Group Bone, Joint and Muscle Trauma Group Breast Cancer Group Childhood Cancer Group Colorectal Cancer Group Consumers and Communication Group Cystic Fibrosis and Genetic Disorders Group Dementia and Cognitive Improvement Group Depression, Anxiety and Neurosis Group Developmental, Psychosocial and Learning Problems Group Drugs and Alcohol Group Ear, Nose and Throat Disorders Group Effective Practice and Organisation of Care Group Epilepsy Group Eyes and Vision Group Fertility Regulation Group Gynaecological Cancer Group HIV/AIDS Group Haematological Malignancies Group Heart Group Hepato-Biliary Group Hypertension Group Incontinence Group

Infectious Diseases Group Inflammatory Bowel Disease and Functional Bowel Disorders Group Injuries Group Lung Cancer Group Menstrual Disorders and Subfertility Group Metabolic and Endocrine Disorders Group Methodology Review Group Movement Disorders Group Multiple Sclerosis Group Musculoskeletal Group Neonatal Group Neuromuscular Disease Group Oral Health Group Pain, Palliative and Supportive Care Group Peripheral Vascular Diseases Group Pregnancy and Childbirth Group Prostatic Diseases and Urologic Cancers Group Public Health Group Renal Group Schizophrenia Group Sexually Transmitted Diseases Group Skin Group Stroke Group Tobacco Addiction Group Upper Gastrointestinal and Pancreatic Diseases Group Wounds Group

Global reachAustraliaCanada DenmarkFinlandIndiaIrelandLatin America &CaribbeanLow-Income CountriesNew ZealandNorwaySouth Africa*SpainSwedenUnited KingdomState of Wyoming*

Impact and impact factor

5.182 Up from 4.654 in 2007

12th highest General Medical journal

Up from 14th in 2007

2 seconds

Impact and impact factor

5.182 Up from 4.654 in 2007

12th highest General Medical journal

Up from 14th in 2007

3 seconds

Impact and impact factor

5.182 Up from 4.654 in 2007

12th highest General Medical journal

Up from 14th in 2007

4 seconds

UK UNITED STATES AUSTRALIA CANADA 0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

2006 Full Text Download 2007 Full Text Download 2008 Full Text Download

Increasing usage

Review Title World Rank

India Rank

Interventions for preventing falls in elderly people 1 47

Interventions for preventing obesity in children 2 178

Cranberries for preventing urinary tract infections 3 410

St John's Wort for major depression 4 439

Interventions for enhancing medication adherence 5 351

Nicotine replacement therapy for smoking cessation 6 69

Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases

7 61

Water for wound cleansing 8 127

Support surfaces for pressure ulcer prevention 9 700

Midwife-led versus other models of care for childbearing women 11 38

Top 10 Reviews - Worldwide

Where are we going?

• Content development

• Delivery of content

Content

Timely

Valid

Accessible

Relevant

Content developments

• Summary of findings tables

• Diagnosis reviews

• Multiple comparison meta-analysis

• Overviews of reviews

Content developments

• Global Health commitment– Advocacy– Capacity building– Work with WHO and other partners

• Complex reviews

• Health Equity Methods Group

GRADE and Summary of Findings table

Delivery: the web programme

• Increasing publication frequency (publish changed data only)

• Improved search and browse

• Clarification of content

• Web 2.0 / interactivity etc

Delivery: different vehicles

• Cochrane Journal Club

• Cochrane PICO

• Cochrane on handhelds

• Cochrane decision support

Format Description Objective Frequency

Web programme

Improved web presentation and frequency of publication

To improve quality and timeliness of content, and engage users

Monthly!

Cochrane Education

Education materials related to the content of reviews building on Journal Club

To improve accessibility of our reviews and engage with users

Not yet determined

Cochrane Response

Responsive review service to customers

To improve relevance and increase use of cochrane reviews in guidelines

On demand!

Cochrane PICO An concise summary of evidence from Cochrane Reviews aimed at a specific question

To improve accessibility, to act as a user friendly spring board into the evidence

Pilot due May 2010

New for The Cochrane Library in 2010

Participation

Quality

Usage

How can we measure success?

Global health

progress

thanks for listeningdtovey@cochrane.org