Producing Cochrane Reviews

By Adem Lewis / in , , /

My name is…
[in several languages] [music]>>Cates: At the time I was
working in general practice. One of the things that I noticed was that people came in with their asthma inhalers and with spacer devices
(they’re like plastic chambers) and I’d say, “Can you show me
how you use your device?” and they would. They’d take it
and they’d use it and, and they’d, they’d know that it was the right way to do it
because that’s how they were shown to use it. But what struck me was, over the course of the
time I was doing this, they all did it differently and they all knew they were right. So I thought, “Well, this
is a question that’s interesting because there’s diversity of opinions
and everybody’s sure about it. So let’s, let’s try and find out.” [music] So I went along and spoke to Steve who
was the Managing Editor who was very helpful. He said, “Oh, yes, yes, we have this new
database we can find all the studies for you.” He said, “We’ll help you answer
the question.” And then he said, “Oh, and would you like
to write a systematic review?” So I said, “What’s that?” And he said, “Oh, don’t worry,
don’t worry. We’ll, we’ll teach you how to do it.” So then I said, I asked him, what I thought was quite a good question,
which was, “How do you know I can do it?” [music]>>Foxlee: A systematic review
is an attempt to answer a question, so a common clinical question. I know, somebody tells me, that garlic, if I get a cold,
garlic is a really good thing to take for a cold. So, usually you’ve got an intervention
or some preventative strategy for a condition, that’s the way most, that’s the vast majority of
our questions, are those simple kind of clinical question. So what a systematic review is attempting to do is to find all of the relevant data, but it’s a very specific type of data,
randomised controlled trials data, that would address that question. >>Cumpston: Then what we do is we bring together all the
studies that have been conducted to answer that question, we appraise them to see whether
we think they are reliable or not, and then we summarise their results together so we get
a complete picture of the body of evidence on that question.>>Foxlee: When you pool all those estimates,
you get, what you get is a systematic review. The systematic part is that you have to be
systematic in your searching of the literature. You have to be systematic in the
methods that you use to evaluate. Because anybody can write
a review of the literature. I could pick my favorite 10 trials about
whether garlic works for the common cold because they shore up some pre-, because they
shore up my idea about what the answer to that question is, but a systematic review means you’re
looking for all of the evidence, all of the evidence you can possibly
find to answer that question. Crunch the numbers, get an answer.>>Cumpston: So it will tell us
either it works or it doesn’t work or maybe we don’t know yet. Maybe we do
need more studies for a particular question. And sometimes it will tell
us who it works best for, and what version of the
treatment might work best. [music]>>Bell-Syer: Each Cochrane Review Group
has a specific disease type. So we look after people
who have a wound. That can be an acute wound
or a chronic wound, and we also look at the
complications of wounds and we also deal with infection,
so wound infection.>>Foxlee: There’s the Eyes and Vision Group, there’s the Renal Group, there’s Airways Group, etc. They are kind of like, I guess you can think of
them as the engine room of review production. So authors make contact with
a Cochrane Review Group – that’s where they get all of their guidance
in terms of how to write the review. >>Cates: I got taught how to do it. I had a superb
editor who took me through the different stages. And I wrote a protocol about
using spacers in acute asthma. And it then became a review
and the review was published.>>Bell-Syer: So somebody coming to us wanting
to do a systematic review will contact us and then we’ll start a dialogue with them
about the question they want to ask. Whether that’s been done before,
or if not, if it’s a new question, if it’s the right question,
and we work with them to get that right.>>Foxlee: Every group has a Managing Editor, it has a
Trials Search Co-ordinator, and it has a Co-ordinating Editor.>>Skoetz: The Managing Editor is more involved
in the direct contact with the authors, and the Co-ordinating Editor co-ordinates the editors and the
peer reviewers, checking all the reviews before they can be published, and to sign off the reviews. There’s a huge quality
check before a Cochrane Review can be published.>>Richter: Reviewers are actually coming from all
over the world and we have more than – currently – 600 authors. Well, covering almost any country in the world.>>Cates: We have a big group in Australia,
a big active group of reviewers in Australia. We have editors and reviewers in
Canada, in America, southern Europe.>>Bell-Syer: Our authors and our editors and our
peer reviewers and the people who interact with us can be anywhere, and our contact
with them is almost always on email.>>Narrator: As the Collaboration has grown, the scope
of its reviews has moved beyond clinical interventions.>>Waters: We’re the second most recent
Review Group in the Collaboration and, at the moment, we’ve got 30 titles, but they are titles that span across education,
agriculture, transport, food access, slum upgrading. So, we’re trying to address the causes of causes
so much more upstream issues in relation to health outcomes.>>Cuervo: [Spanish] If the Collaboration held rigidly
to only reviewing the clinical aspects and two-arm trials, it would
probably lose relevance quickly. We know that the problem isn’t just to find what is effective,
rather how to scale it up for the benefit of everyone, to improve health and equity among people.>>Waters: And what we’re seeing over time is that the way
in which trials have been done and research have been done is that by including what was not there in previous
research – we’re starting to see that filled. So we see many more studies now
that have got cost effectiveness in them. Many more studies that
are mixed method studies. Many more that are really trying to work out,
did they make a difference to everyone equally or did they just work for higher
income people or more educated people? So the evidence base
has shifted remarkably, and by updating frequently and using a public health
paradigm incorporated into the systematic methods it’s been really able to shift the field.>>Narrator: The Collaboration has also become involved
in preparing reviews of diagnostic test accuracy.>>Deeks: We’re breaking new ground, but the Collaboration has always broken
new ground in the areas it’s researched and nobody’s done reviews on this scale in,
in test evaluation really before. And so we’ve been learning on as we go. Hopefully our reviews are going
to be more useful to decision-makers, than many which are traditionally
published in paper journals. The reviews in paper journals quite often
just focus on saying how good one test is, whereas a decision-maker has to select
between alternative tests. >>Tovey: The argument for
evidence synthesis is strong. If health systems want to use
funds economically, efficiently, to spend their resources where
they are going to be the most effective, if they want to make sure consumers have the information they need
to make decisions, and the same with health professionals, the argument is strong that evidence reviews
made available, made accessible, made digestible are
a large part of that policy. [music]

2 thoughts on “Producing Cochrane Reviews

  1. Does the systematic review is synonymous with evidence based research? and does the evidence based research consider data as evidence? Also how Cochrane review is diferent from Systematic review? I am confused!

  2. to put it imprecisely but simply
    systematic review is a research method to review the evidence, so its a (very important) part of evidence based research and practice
    Cochrane reviews are systematic reviews done by the Cochrane collaboration and published in the online Cochrane Library, always. they are known for their high quality, usually because of the strict criteria and methods used in them, the most important ( in my opinion) being the publication of a protocol before starting a review.

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