Background
Methods
Main category | Subcategories | Further details |
---|---|---|
1. Knowledge production | • Impact within research community | • Number of times review is cited |
• Stimulating debate in research community | ||
• Methodological developments | ||
• Other methods of dissemination | • Press coverage | |
2. Research targeting | • Influence on other research | • Identification of gaps in knowledge |
• Follow-on research | ||
3. Informing policy development (includes actual and potential) | • Impact on national or government policy | • e.g. NICE guidance |
• Impact on international policy | • e.g. WHO guidance, or international professional bodies | |
• Policies agreed at national or local level in the form of clinical or local guidelines | • e.g. Guidance produced by local trusts | |
• Policies developed by those responsible for training and education | • Local or national | |
4. Impact on practice/services (includes actual and potential) | • Evidence-based practice | • The use of research evidence by different groups involved in clinical decision-making |
• Adoption of research findings and health technologies by health-service providers | ||
• Adherence to research-informed policies and guidelines | ||
• Addressing barriers to evidence-based practice (e.g. training) | ||
• Number of mentions in media | ||
• Quality of care | • Efficacy of health services | |
• Availability, accessibility and acceptability of services | ||
• Utilisation and coverage | ||
• Cost containment and cost-effectiveness | ||
• Services management and organisation | • Management of health-service procurement and provisioning (public and private) |
Methods for phase 1: overview of impact of CRG outputs (2007–2011)
Questionnaire survey
Documentary review and analysis of existing sources
Data verification and analysis
Qualitative interviews
Analysis
Methods for phase 2: evaluation of impact of representative sample of Cochrane reviews (2007–2011)
Questionnaire survey with systematic review authors
Documentary and bibliometric analysis
Results
Knowledge production, identifying gaps in the evidence and stimulating research
CRG | Number of reviews | Type and number follow-on research | Review is citeda
| Type of funder |
---|---|---|---|---|
Airways | 1 | RCT | Yes | Not known |
Bones, Joint and Muscle | 2 | 2 RCTs | Yes | Government (1 UK, 1 Australia) |
Cystic Fibrosis | 5 | 5 RCTs | Yes | 3 government (UK), 2 not known |
Depression, Anxiety and Neurosis | 2 | 1 RCT, 1 not known | 1 Yes, 1 not known | 1 government (UK), 1 not known |
Eyes and Vision | 1 | 1 Not known | Yes | 1 charity |
Incontinence | 3 | 3 RCTs | 2 Yes, 1 not known | 3 government (UK) |
Injuries | 7 | 9 RCTs | 7 Yes, 2 not known | 7 government (3 Australia, 3 UK, 1 Denmark), 1 industry, 1 charity |
Neuromuscular | 4 | 3 RCTs, 1 not known | 2 Yes, 2 not known | 2 government (1 USA, 1 France), 1 charity, 1 not known |
Oral | 1 | RCT | Yes | 1 government (UK) |
Pregnancy | 1 | Qualitative | Yes | Not known |
Schizophrenia | 1 | 1 RCT, 2 not known | Not known | Not known |
Skin | 5 | 5 RCTs, 1 not known | 4 Yes, 2 not known | 3 government (UK), 2 charity (2 UK, 1 USA) |
Tobacco Addiction | 2 | 3 RCTs | Yes (all) | 2 government (UK), 1 not known |
CRG | Review IDa
| Year of publication | Downloads 2011 (full text) | WoS | Scopus | GS | Altmetric score |
---|---|---|---|---|---|---|---|
Airways | A1 | 2009 | 477 | 35 | 35 | 59 | 6 |
A2 | 2009 | 2,195 | 49 | 80 | 168 | 6 | |
A3 | 2011 | 1,760 | 4 | 9 | 41 | 0 | |
Bone, Joint and Muscle | B1 | 2007 | 3,047 | 66 | 123 | 248 | 8 |
B2 | 2009 | 9,602 | 348 | 467 | 737 | 77 | |
B3 | 2010 | 6,581 | 96 | 42 | 242 | 39 | |
Cystic Fibrosis | C1 | 2009 | 939 | 10 | 8 | 25 | 0 |
C2 | 2008 | 356 | 4 | 12 | 19 | 0 | |
C3 | 2007 | 274 | 15 | 18 | 43 | 0 | |
Dementia and Cognitive Improvement | D1 | 2008 | 1,660 | 37 | 59 | 100 | 1 |
D2 | 2009 | 705 | 58 | 104 | 147 | 2 | |
D3 | 2007 | 2,599 | 42 | 104 | 185 | 2 | |
Depression, Anxiety and Depression | DA1 | 2007 | 1,019 | 8 | 10 | 24 | 0 |
DA2 | 2008 | 5,080 | 138 | 235 | 441 | 51 | |
DA3 | 2008 | 1,134 | 51 | 83 | 276 | 1 | |
Ear, Nose and Throat | ENT1 | 2008 | 313 | 9 | 11 | 18 | 1 |
ENT2 | 2007 | 971 | 56 | 103 | 168 | 11 | |
ENT3 | 2007 | 725 | 121 | 260 | 338 | 1 | |
Epilepsy | E1 | 2008 | 147 | 7 | 19 | 32 | 0 |
E2 | 2011 | 427 | 1 | 1 | 10 | 2 | |
E3 | 2008 | 1,187 | 17 | 40 | 100 | 0 | |
Eyes and Vision | EV1 | 2007 | 367 | 1 | 11 | 45 | 0 |
EV2 | 2009 | 417 | 0 | 2 | 65 | 0 | |
EV3 | 2009 | 704 | 12 | 21 | 34 | 3 | |
Gynaecological Cancer | GC1 | 2007 | 364 | 23 | 28 | 64 | 1 |
GC2 | 2011 | 295 | 53 | 21 | 129 | 0 | |
GC3 | 2008 | 383 | 28 | 48 | 61 | 0 | |
Heart | H1 | 2008 | 618 | 16 | 47 | 95 | 13 |
H2 | 2011 | 10,453 | 54 | 65 | 282 | 34 | |
H3 | 2010 | 2,440 | 56 | 75 | 225 | 1 | |
Incontinence | IN1 | 2007 | 215 | 10 | 10 | 15 | 0 |
IN2 | 2011 | 449 | 4 | 2 | 5 | 0 | |
IN3 | 2010 | 774 | 6 | 5 | 11 | 0 | |
Injuries | IJ1 | 2008 | 127 | 7 | 11 | 13 | 0 |
IJ2 | 2007 | 3,720 | 86 | 201 | 735 | 106 | |
IJ3 | 2007 | 1,373 | 81 | 188 | 595 | 0 | |
Neuromuscular | NM1 | 2009 | 222 | 8 | 7 | 9 | 0 |
NM2 | 2008 | 414 | 14 | 29 | 46 | 1 | |
NM3 | 2008 | 761 | 57 | 127 | 305 | 0 | |
Oral Health | O1 | 2008 | 489 | 2 | 5 | 6 | 0 |
O2 | 2007 | 413 | 2 | 15 | 14 | 11 | |
O3 | 2010 | 1,276 | 25 | 15 | 103 | 13 | |
PaPaS | P1 | 2009 | 1,589 | 58 | 103 | 151 | 7 |
P2 | 2008 | 2,238 | 27 | 86 | 139 | 4 | |
P3 | 2008 | 2,200 | 93 | 176 | 276 | 69 | |
Pregnancy and Childbirth | PC1 | 2008 | 569 | 13 | 27 | 37 | 0 |
PC2 | 2008 | 323 | 11 | 16 | 34 | 0 | |
PC3 | 2010 | 3,258 | 29 | 16 | 499 | 37 | |
Schizophrenia | SCH1 | 2008 | 222 | 5 | 7 | 20 | 3 |
SCH2 | 2010 | 1,666 | 7 | 16 | 74 | 1 | |
SCH3 | 2008 | 2,560 | 30 | 59 | 103 | 2 | |
Skin | SK1 | 2007 | 624 | 14 | 29 | 67 | 0 |
SK2 | 2009 | 327 | 5 | 10 | 16 | 0 | |
SK3 | 2009 | 581 | 16 | 19 | 70 | 0 | |
Tobacco Addiction | T1 | 2008 | 903 | 42 | 89 | 162 | 1 |
T2 | 2009 | 762 | 40 | 61 | 126 | 2 | |
T3 | 2010 | 1,481 | 33 | 31 | 123 | 17 | |
Wounds | W1 | 2008 | 3,487 | 12 | 27 | 51 | 0 |
W2 | 2011 | 123 | 3 | 0 | 5 | 4 | |
W3 | 2008 | 1,088 | 37 | 43 | 102 | 3 |
WoS | Scopus | Google scholar | |
---|---|---|---|
Total number of citations (all 60 reviews combined) | 2,192 | 3,562 | 8,333 |
Mean number of citations | 36.5 | 59.3 | 138.8 |
Median number of citations | 20 | 28.5 | 72 |
Interquartile range | 7–51 | 11–80 | 25–168 |
Variation in counts | 0–348 | 0–467 | 5–737 |
Informing policy development
CRG | Total number of citations | Number of reviews cited in guidelines/guidance | Total number of guidelines | Level of guideline | ||
---|---|---|---|---|---|---|
International | National | Local | ||||
Airways | 54 | 45 | 16 | 3 | 13 | 0 |
BJM | 18 | 12 | 9 | 0 | 8 | 1 |
Cystic Fibrosis | 16 | 15 | 13 | 3 | 9 | 1 |
DAN | 84 | 52 | 26 | 10 | 16 | 0 |
Dementia and Cognitive Improvement | 14 | 14 | 5 | 1 | 4 | 0 |
ENT | 33 | 21 | 17 | 3 | 14 | 0 |
Epilepsy | 8 | 7 | 3 | 1 | 2 | 0 |
Eyes and Vision | 8 | 6 | 6 | 0 | 3 | 3 |
Gynaecological Cancer | 7 | 7 | 3 | 0 | 3 | 0 |
Heart | 37 | 19 | 26 | 5 | 21 | 0 |
Incontinence | 29 | 22 | 9 | 1 | 8 | 0 |
Injuries | 42 | 29 | 18 | 8 | 10 | 0 |
Neuromuscular | 8 | 6 | 7 | 5 | 2 | 0 |
Oral Health | 47 | 17 | 25 | 1 | 20 | 4 |
PaPaS | 48 | 33 | 20 | 4 | 15 | 1 |
Pregnancy and Childbirth | 129 | 85 | 33 | 15 | 18 | 0 |
Schizophrenia | 57 | 43 | 8 | 8 | 6 | 0 |
Skin | 20 | 14 | 14 | 3 | 11 | 0 |
Tobacco Addiction | 22 | 18 | 7 | 0 | 7 | 0 |
Wounds | 41 | 25 | 11 | 1 | 10 | 0 |
Organisation | Number of participants | Role |
---|---|---|
NICE - internal | 2 | Technical analyst, clinical guidelines team × 2 |
NICE - external collaborating centres | 2 | Senior systematic reviewer × 2 |
SIGN | 2 | Evidence and information scientist × 1 |
Programme manager × 1 | ||
WHO | 2 | Senior manager × 2 |
Themes and subthemes | Barriers and facilitators |
---|---|
Theme 1. The process of using Cochrane reviews (CRs) in the development of guidance | |
• CRs used early in process/used in development phase | Barriers |
• Systematic reviews top of evidence hierarchy/priority over other forms of evidence | • CRs may not be available, may not fit with guideline scope |
• Guideline developers (GD) will use CR if available, but not always possible—CR may not be available/may not ‘fit’ | • CR may be out of date |
• GD may use whole CR or parts of CR (e.g. using evidence tables)/parts used vary | Facilitators |
• CRs can save GD time (e.g. using existing searches/data) | • Similar evidence hierarchy |
• GD may build on work of Cochrane reviewers/existing reviews | • Cochrane processes for searching/ identifying studies seen as reliable and thorough |
• GD may redo the review (depending on resources) | • Similar processes for critical appraisal |
• Structure of CR means that GD can use all or part of it | |
Theme 2. Quality of Cochrane reviews | |
• Cochrane is a respected/trustworthy brand | Barriers |
• Transparent/easy to replicate | • Quality not always good |
• Robust methods | • Quality may be poorer in older reviews |
• Variable quality (not all good) | Facilitators |
• Perception that quality may be poorer in older reviews | • Generally respected/trustworthy brand |
• Robust methods that can be replicated | |
Theme 3. Culture and approaches | |
• Cochrane and GD have similar attitudes towards evaluating and appraising evidence | Barriers |
• Cochrane reviews routinely used to inform guideline development process | • Different time frames and resources |
• Some differences in methods (e.g. CR double data extraction but some GD not) | • Different priorities of Cochrane and GD |
• Role of judgement (part of guideline development process but not CR) | • Different needs and perspectives |
• Cochrane and GDs may have different scopes/focus/drivers behind review questions | Facilitators |
• Tensions between different perspectives and interests (e.g. academic/clinical/policy) | • Similar attitudes towards evaluating and synthesising evidence |
• Resources—different time frames and sources of funding | • Cochrane embedded in culture of guidelines |
Theme 4. Up-to-date evidence | |
• CRs can be out of date (become out of data quickly) | Barriers |
• Some confusion around dates of updates | • Cochrane too slow to update |
• Some GD (e.g. WHO) work with CRGs to update reviews (they fund this) | • Lack of resources to fund reviews/updates |
• Delay in publication/updating | • Slow editorial processes |
Facilitators | |
• Guideline developers fund CRG to update review | |
Theme 5. Methodological issues | |
• Newer is better (newer CRs seen as methodologically better) | Barriers |
• May be statistical issues (wrong data/statistical methods—barrier to use) | • Statistical issues (e.g. CR not used outcome measures, statistics GD want) |
• Lack of clarity on which follow-up data used from papers | • Need for network meta-analysis and comparative analysis reviews |
• Network meta-analysis, comparative analysis reviews | • Lack of facilities for sharing data |
• GRADE (NICE have to use it, Cochrane do not) | |
• Cochrane focus on RCTs—not always appropriate, particularly for public health | |
• GD want better facilities for sharing and reanalysing data from CRs | |
Theme 6. Collaboration/communication | |
• Good communication improves use of review | Barriers |
• Timing of communication is important | • Problems communicating with review authors and CRGs |
• Dialogue/clear communication/negotiation important with appropriate persons | • Issues of ownership and authorship |
• Collaboration and positive engagement might help speed things up | Facilitators |
• Close collaboration between WHO and certain Cochrane groups | • Good communication between GD and authors or CRGs improves use of CR (timing important) |
• Formal links between CRG and guideline developers to promote use of CR | • Financial support |
• GD experience problems communicating with CRGs | |
• Issues of ownership/authorship—recognition and reward |
Impact on clinical practice and services
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Reviews on long-acting beta-antagonists (LABA) in asthma[29‐31] may have led to safer prescribing of these drugs for people with asthma (http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm200776.htm).
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An updated review on antiviral treatment for Bell’s palsy[35] may have contributed to changes in practice and a reduction of prescriptions of antiviral drugs for Bells palsy (http://cks.nice.org.uk/bells-palsy).
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A review on antifibrinolytic drugs for trauma patients[36, 37] led to follow-on research which influenced the decision by the Medicines Innovation Scheme to fast track tranexamic acid for use in the NHS. Ambulance crews throughout the NHS now administer tranexamic acid to bleeding trauma patients (http://www.swast.nhs.uk/txa.htm).