Cochrane (organisation)

Cochrane
Motto Trusted evidence. Informed decisions. Better health.
Formation 1993 (1993)
Type International NPO
Purpose Independent research into data about health care
Headquarters London, England [1]
Region served
 Worldwide
Official language
 English
Steering Group Co-Chairs
 Lisa Bero,
Cindy Farquhar[2]
Volunteers
 Over 37,000 (2015) [3]
Website www.cochrane.org

Cochrane, previously known as the Cochrane Collaboration, is an independent, non-profit, non-governmental organization consisting of a group of more than 37,000 volunteers in more than 130 countries.[3] The group was formed to organize medical research information in a systematic way to facilitate the choices that health professionals, patients, policy makers and others face in health interventions according to the principles of evidence-based medicine.[4][5]

The group conducts systematic reviews of randomized controlled trials of health-care interventions and diagnostic tests, which it publishes in The Cochrane Library.[6][7] A few reviews (in fields such as occupational health) have also studied the results of non-randomized, observational studies.[8]

History

Cochrane was founded in 1993 under the leadership of Iain Chalmers. It was developed in response to Archie Cochrane's call for up-to-date, systematic reviews of all relevant randomized controlled trials of health care.[9][10][11]

Cochrane's suggestion that the methods used to prepare and maintain reviews of controlled trials in pregnancy and childbirth should be applied more widely was taken up by the Research and Development Programme, initiated to support the United Kingdom's National Health Service. Through the NHS R&D programme, led by the first Director of Research and Development Professor Michael Peckham,[12] funds were provided to establish a "Cochrane Centre", to collaborate with others, in the UK and elsewhere, to facilitate systematic reviews of randomized controlled trials across all areas of health care.[13][14]

Cochrane is currently concentrating on capacity building in health research is individuals, groups, and institutions in low- and middle-income countries (LMIC)s.[15]

Logo

The Cochrane logo illustrates a meta-analysis of data from seven randomized controlled trials (RCTs), comparing one health care treatment with a placebo in a forest plot. The diagram shows the results of a systematic review and meta-analysis on inexpensive course of corticosteroid given to women about to give birth too early – the evidence on effectiveness that would have been revealed had the available RCTs been reviewed systematically a decade earlier. This treatment reduces the odds of the babies of such women dying from the complications of immaturity by 30–50%. Because no systematic review of these trials had been published until 1989, most obstetricians had not realized that the treatment was so effective and therefore many premature babies have probably suffered or died unnecessarily.[16]

Reception

An editorial in the Canadian Medical Association Journal in 2004 noted that Cochrane reviews appear to be more updated and of better quality than other reviews and due to their standardized methodologies, was "the best single resource for methodologic research and for developing the science of meta-epidemiology." Their work has also led to methodological improvements in the medical literature. However, the editorial also noted areas for improvement remained, including adequately assessing potential harms from medical interventions and providing a more user-friendly format as well as promoting international collaboration.[17]

Studies comparing the quality of Cochrane meta-analyses in the fields of infertility,[18] physiotherapy[18][19] and orthodontics,[20] to those published by other sources have concluded that Cochrane Reviews incorporate superior methodological rigor. A broader analysis across multiple therapeutic areas reached similar conclusions but was performed by Cochrane authors.[21] Compared to non-Cochrane reviews, those from Cochrane are less likely to reach a positive conclusion about the utility of medical interventions.[22] Key criticisms that have been directed at Cochrane's studies include a failure to include a sufficiently large number of unpublished studies, failure to pre-specify or failure to abide by pre-specified rules for endpoint[23] or trial[24] inclusion, insufficiently frequent updating of reviews, an excessively high percentage of inconclusive reviews,[25] and a high incidence of ghostwriting and honorary authorship.[26][27] In some cases Cochrane's internal structure may make it difficult to publish studies that run against the pre-conceived opinions of internal subject matter experts.[28]

An ongoing systematic review being performed by Cochrane authors will examine the potential impact of selective inclusion of results in meta-analyses, comparing Cochrane to non-Cochrane studies.[29]

Organization

Cochrane's chief operational units, all ultimately reporting to the Steering Group (Board of Trustees), include:

Cochrane Centres

There are 14 Centres and 19 regional Branches.[1][31]

Australasian Cochrane Centre

The Australasian Cochrane Centre is based at Monash University in Melbourne, Australia. It is funded by the Australian Government through the NHMRC.[32]

Cochrane Brazil

Cochrane Brazil[33] was established in 1996 and is connected to the Federal University of São Paulo (UNIFESP) Post-Graduate Program in Evidence-Based Healthcare. It is a training center in systematic literature reviews and research methodology and, in addition to the teaching activities, with workshops and online courses, Cochrane Brazil acts also offering scientific consulting for specific research projects.

Cochrane Brazil has a scientific production comparable to similar institutions of European countries. It works as a laboratory for primary clinical research and for the production of systematic reviews of the literature, having published more than 200 articles in international journals, with new scientific evidence to assist in decision making about health.

Cochrane Brazil also performs systematic reviews and other studies commissioned by the Brazilian Ministry of Health to verify the effectiveness and cost-effectiveness of preventive and treatment procedures and technologies to be adopted by public hospitals and primary care centers of the National Health System (SUS). Cochrane Brazil has offered one-year courses in Evidence Based Medicine and systematic reviews to nearly 10,000 health professionals working for the Ministry of Health in 25 of the 27 Brazilian states who are responsible for evaluating technologies, medicines and medical equipment for the SUS.

Cochrane Canada

Cochrane Canada was established as the second global Cochrane Centre in 1993 to cultivate evidence-based decision-making by promoting the use and accessibility of Cochrane Reviews. Cochrane Canada is located at the Centre for Practice Changing Research at the Ottawa Hospital Research Institute and acts as the central point of contact for Cochrane in Canada by:

In Canada there are five Cochrane Review Groups (Cochrane Back, Cochrane Hypertension, Cochrane IBD, Cochrane MSK, and Cochrane Upper GI and Pancreatic Diseases), four Cochrane Methods Groups (Applicability, Equity, Non-Randomized Studies, and Reporting Bias) and the Cochrane Child Health field.

Cochrane Canada also benefits from the Cochrane Policy Liaison Office located at McMaster University, which establishes and maintains liaisons with policy makers.

The Québec Branch of Cochrane in Canada was launched in 2013 by the Université Laval, Faculty of Medicine, in partnership with the CHU de Québec.

South Asian Cochrane Network and Centre

The South Asian Cochrane Network & Centre (SASIANCC)[34] is a part of the global Cochrane network and is located at the Christian Medical College, Vellore, India. The centre, originally the South Asian Cochrane Centre, was established in January 2004, as a branch of the Australasian Cochrane Centre, with geographical responsibility for South Asia (Afghanistan, Bangladesh, Bhutan, India, Sri Lanka, Pakistan, the Maldives and Nepal). SASIANCC is hosted by the Prof Bhooshanam V Moses Centre for Evidence-Informed Healthcare at the Carman Block at the Christian Medical College (CMC) Campus, Bagayam, Vellore since December 2004. In July 2008 it was re-designated as an independent centre of The Cochrane Collaboration, with a co-ordinating centre at the Christian Medical College, Vellore, in India, and five network sites in India, two in Pakistan, one in Sri Lanka, and one in Bangladesh.

Its projects have included the National Snakebite Survey in India,[35] the South Asian Toxicology Network, the Cochrane Student Journal Club[36] and the South Asian Database of Controlled Clinical Trials.

Cochrane UK

Cochrane UK[37] is the original Cochrane Centre and is primarily funded by the National Institute for Health Research (NIHR).

Almost half of all Cochrane Review Groups are based or have bases in the United Kingdom; almost 34% of all Cochrane authors are based in the UK.[38]

Cochrane UK activities include: The Learn + Teach Programme, The Engagement Programme, Students for Best Evidence and The Guidelines Project.[39]

Cochrane United States

Cochrane United States was established in December 2002 and operates out of three offices.[40] The main office is headquartered at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. Cochrane US is dedicated to promoting awareness of Cochrane and its objectives and access to the Cochrane Library in the United States. The main office in Baltimore is responsible for, among other things, providing training and support for review authors, Trials Search Coordinators, Review Group Coordinators, editors, handsearchers, consumers and others.[41]

A special function of the Center is to support Consumers United for Evidence-based Healthcare (CUE), a partnership with health and consumer advocacy organizations interested in integrating understanding and interpretation of evidence-based healthcare into their advocacy activities, strengthening the voice of consumers in healthcare research, and providing leadership in these areas. From 1994 to 2005, the Cochrane US coordinated development of the Cochrane Central Register of Controlled Trials (CENTRAL), a source of reports of controlled clinical trials worldwide, a master list of journals being searched, and handsearcher training.

The San Francisco Branch of the Center operates out of the University of California, San Francisco and develops and evaluates systems for assessing and sustaining the quality of Cochrane reviews.

The Caribbean Branch was launched in June 2013 and is the reference center for English-speaking Caribbean territories. The branch is housed at the University of the West Indies in Mona, Jamaica.

Cochrane Review Groups

There are 53 Cochrane Review Groups within the Collaboration, covering different subject areas in healthcare.[1][42] The contributors to these groups vary from researchers to consumers of healthcare services to healthcare professionals.

Cochrane Acute Respiratory Infections

Cochrane Acute Respiratory Infections was registered in 1994. Its editorial base is currently located in the Bond University in Australia. The group deals with healthcare interventions aimed at prevention, treatment and rehabilitation aspects of acute respiratory infections including diphtheria, meningitis, measles and chickenpox. About 175 systematic reviews have been conducted under its purview.

Cochrane Back

Cochrane Back was founded in 1998 and is based at the Institute for Work and Health in Toronto, Canada. The group manages reviews on diagnosis, primary and secondary prevention and treatment of neck and back pain and other spinal disorders, excluding inflammatory diseases and fractures.

Cochrane Eyes and Vision

Cochrane Eyes and Vision has been registered with Cochrane since 1997. Its editorial base is located at the London School of Hygiene & Tropical Medicine in London, England, with a satellite group at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.[43] The group prepares systematic reviews of all the interventions used to prevent or treat eye diseases and/or visual impairment.[44][45] Additionally, the group considers the evidence for interventions that aim to help people adjust to visual impairment or blindness.

Cochrane Hypertension

Cochrane Hypertension was registered in May 1996 and has been based at the University of British Columbia in Vancouver, Canada since 2001. This group focuses on interventions evaluating blood pressure for the prevention and treatment of essential hypertension.

Cochrane IBD

Cochrane IBD (Inflammatory Bowel Disease and Functional Bowel Disorders) originally began as the Inflammatory Bowel Disease Group in February 1995. The group is located at the University of Western Ontario in London, Canada and addresses interventions directed at ulcerative colitis and Crohn's disease with a secondary interest in other intestinal disorders including Clostridium difficile-associated diarrhea, antibiotic-associated diarrhea, microscopic colitis, collagenous colitis, lymphocytic colitis, irritable bowel syndrome, chronic constipation and diarrhea.

Cochrane Musculoskeletal

Cochrane Musculoskeletal has been registered with Cochrane since 1993. Its editorial base is currently located at the University of Ottawa in Canada, with satellite groups at Cabrini Institute, Melbourne, Australia, at the University of Alabama at Birmingham, United States, and at the Hôtel-Dieu de Paris, Université Paris Descartes, France.[46] The group prepares up-to-date reviews for the treatment, prevention or rehabilitation of musculoskeletal disorders.[47][48] Additionally, also provides secondary products to make the evidence more friendly for those involved in treatments for musculoskeletal diseases.[49]

Cochrane Work

Cochrane Work[50] publishes reviews of the effectiveness of interventions to reduce occupational diseases, injuries and disability. Currently there are 126 review work-related topics in the Cochrane Library. The editorial base is located in Kuopio, Finland and funded by the Finnish Institute of Occupational Health. The impact factor of the reviews it produces was 6.4 in 2014.

Cochrane Vascular

Cochrane Vascular has been registered with Cochrane since 1995 and is based within the University of Edinburgh, Scotland. Cochrane Vascular has a world-wide membership composed of medical and surgical specialists, hospital administrators, policy makers, statisticians and healthcare consumers who help produce systematic reviews encompassing all surgical and medical interventions for the prevention or treatment of arterial and venous diseases.[51]

Cochrane Upper GI

Cochrane Upper GI is located at McMaster University in Hamilton, Canada and began in June 1998. It prepares and maintains systematic reviews to answer questions on the prevention, treatment and rehabilitation of benign and malignant upper gastrointestinal and pancreatic diseases. This includes disorders of the oesophagus, stomach, duodenum and pancreas.

Cochrane Wounds

Cochrane Wounds[52] was registered with Cochrane in 1995 and was based at the University of York from 1994 until 2015 when it re-located to the University of Manchester, UK.

Cochrane Methods Groups

There are 16 Cochrane Methods Groups, covering different aspects of methods used in Cochrane Reviews.[1][53] The contributors to these groups include researchers, methodologists and statisticians. .

Cochrane Adverse Effects Methods Group

The Cochrane Adverse Effects Methods Group (AEMG)[54] was registered with Cochrane on June 14, 2007. Their aim is to develop high quality systematic review methods and to contribute to the validity and precision of systematic reviews by advising Cochrane in regards to the same.

The focus of the Cochrane Adverse Effects Methods Group is to:

Cochrane Agenda and Priority Setting Methods Group

The Agenda and Priority Setting Methods Group is a method group of The Cochrane Collaboration and was formed officially in 2011 to develop and advise methodologies to set research agenda or research priorities. It is currently based in Plymouth University, UK.[55] This group shares ways to improve the validity and precision of systematic reviews can be improved. In addition to informing Cochrane entities about available empirical evidence for setting up research agendas and the establishment of top research priorities. The group also serves as a discussion forum connecting individuals or groups with an interest in methods to set research agendas or priorities.

Cochrane Applicability and Recommendations Methods Group

The Cochrane Applicability and Recommendations Methods Group(ARMG) endeavors to provide guidance for reviewers when they are faced with finding answers for who is the population the systematic review results will apply to and the implications of the review for patients and policy?" This guidance is useful as using only inclusion/exclusion criteria of trials can be insufficient ad it limits the basis for generalisation to a larger population. Procedural clarity is optimal for application of getting the evidence into practice and to provide a straightforward path for the activity of policy making. The group members have developed a brief guide for reviewers regarding optimal applicability and help with methods.

Campbell & Cochrane Equity Methods Group

The Campbell and Cochrane Equity Methods is co-registered with the Cochrane Collaboration and the Campbell Collaboration. It is based at the London School of Hygiene and Tropical Medicine and the University of Ottawa. The group encourages authors of Campbell and Cochrane systematic reviews to consider the effect of the interventions on the disadvantaged or their ability to reduce inequities in health.[56] The group provides guidance to authors who want to incorporate equity into their reviews and has developed tools for planning, conducting, and reporting these systematic reviews.[56]

Cochrane Fields

There are 11 Field Groups (counting the Cochrane Consumer Network, which is treated in the section below).[1][57] These are responsible for dissemination of Cochrane Reviews. The contributors to these groups are varied and include consumers,students, authors,academics, clinicians and researchers.

Cochrane Consumer Network

In October 1995 the Collaboration formed the Cochrane Consumer Network[58] to incorporate patient perspectives into the review process. Shortly thereafter, new "plain language summaries" provided users with a jargon-free synopsis of each systematic review.[59][60]

Partnerships

AllTrials
Campbell Collaboration
Wikipedia

In October 2013, Wikipedia and Cochrane announced a collaborative venture, the announced goals of which include increasing the incorporation of Cochrane research in Wikipedia articles and providing Wikipedia editors with additional resources and assistance in interpreting medical data.[61] Cochrane and John Wiley and Sons, the publisher of the Cochrane Reviews, provide financial support for the collaboration in the form of 100 free Cochrane Reviews accounts made available to Wikipedia medical editors, the financial value of which has been estimated by Cochrane at $30,000 to $80,000 dollars per annum. Other support includes a nominal stipend and travel expenses for a Wikipedian in Residence at Cochrane.[62]

In 2014 the Cochrane blog hosted a rebuttal written by four Wikipedia medical editors, in response to an article critical of the accuracy of Wikipedia medical content published in the Journal of the American Osteopathic Association.[63][64]

Wiley
World Health Organization

The collaboration formed an official relationship in January 2011 with the World Health Organization (WHO) as a partner non-governmental organization with a seat on the World Health Assembly to provide input into WHO resolutions.[65][66] This gave Cochrane the right to a non-voting participating representative in WHO meetings, including the World Health Assembly, which allows Cochrane to make expository statements on WHO health resolutions.[67] The collaboration is also active in providing evidence for good practice during disaster relief and humanitarian crisis through a partnership with Evidence Aid.

References

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  56. 1 2 "Welcome". Equity Methods Group. Retrieved 2014-06-18.
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  67. ↑ "World Health Organization | Cochrane". www.cochrane.org. Retrieved 2015-10-17.

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