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The Cochrane Collaboration

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    • 1. The Cochrane Collaboration’s Prioritization Approaches Lorne Becker: Co-Chair, Cochrane Collaboration Steering Group US Cochrane Center Conference on Priority Setting for Systematic Reviews July 10 2008, Baltimore, USA
    • 2. Outline of presentation
      • Dangers & difficulties in prioritization
      • Cochrane approaches to prioritization
        • Individual Cochrane “entities”
        • Organization-wide
    • 3. Dangers and difficulties
        • Is prioritization compatible with the Cochrane way of doing things?
        • What are the opportunity costs?
        • Whose priorities would we follow?
    • 4. How Cochrane Review Topics are Chosen
      • Curiosity driven
      • Investigator-initiated
      • Peer-reviewed
    • 5. Cochrane Decision Making
      • Primarily bottom up
        • Authors’ interests
        • Scope of editorial group (CRG)
      • Minimally top down
        • Methods
        • Procedures
        • Updating
    • 6. 10 Cochrane Principles
      • #2 - Building on the enthusiasm of individuals,
      • - by involving and supporting people of different skills and backgrounds.
    • 7. Opportunity Costs of Prioritization
    • 8. Could Prioritization Help Focus Collaboration Efforts?
      • Prioritization helps decide what not to do
      • Cochrane aim is to build a comprehensive database of reviews
        • What to do first
    • 9.
        • Whose priorities should we use?
    • 10. Who Are Our Stakeholders?
    • 11. Who Are Our Stakeholders?
    • 12. Who Are Our Stakeholders?
    • 13. Who Are Our Stakeholders?
    • 14. Priority setting
      • Be sure not to miss important perspectives or stakeholders
    • 15. How would these Cochrane reviews have been prioritized?
      • Routine perineal shaving on admission in labor
      • Episiotomy for vaginal birth
    • 16. Countries With Cochrane Contributors
    • 17. Diabetes Prevalence www.WorldMapper.org
    • 18. Tuberculosis Prevalence www.WorldMapper.org
    • 19. HIV Prevalence www.WorldMapper.org
    • 20. Women Smokers www.WorldMapper.org
    • 21. Location of Cochrane Review Groups
    • 22. Cochrane Authors (2007)
    • 23. Who Are Potential Readers?
    • 24. One Click Free Access
    • 25. Cochrane Prioritization Processes
      • Until 2006
      • No central prioritization process
      • Each of the 52 editorial groups responsible for setting its own priorities
      • Variety of approaches
    • 26. Skin Group
      • 21 titles proposed for development
      • Resources allow only 6
      • Vote by Skin Group Members vote to rank titles in order of priority.
        • Authors
        • Editors
        • Peer reviewers
        • Consumers
    • 27. Skin Group – results of prioritisation
      • Sentinel node biopsy followed by elective node dissection for early malignant melanoma.
      • Maintenance treatment for chronic plaque type psoriasis.
      • Topical corticosteroids for atopic eczema.
      • Interventions for erosive lichen planus.
      • Interventions for mycosis fungoides.
      • Concomitant hyperthermia and radiation for recurrent or metastatic malignant melanoma.
    • 28. Renal Group
      • Examination of Trial Register by staff
      • Identification of important studies
      • Group studies into broad topical areas
      • Split each topic into several manageable reviews.
      • Post list of priority topics on web site
    • 29. Infectious Diseases Group
      • Interplay of 3 criteria
        • Importance of the topic
        • Number of trials (0, 1, 2+)
        • Availability of experienced author team
    • 30. Importance – Cochrane ID Group
      • 1 – Strategic Importance
        • Known interest from funders, policy makers or other key stakeholders
      • 2 – Potentially Important
        • WHO Millennium Development Goals
        • Health in Developing Countries
      • 3 – Minimal relevance to MDGs
    • 31. Health Promotion & Public Health Group
      • Taskforce of advisors from global health organizations
        • Identified “policy-urgent topics”
      • Literature review for existing SRs
        • List of potential review topics to fill the gaps
      • Prioritization of the list by the Advisor taskforce
      • Dissemination throughout the Collaboration to relevant editorial groups
        • Formation of a Health Promotion & Public Health editorial group
      J Epidemiol Community Health 2005;59:193–197
    • 32. Steering Group Perspective
      • A key recommendation of the 2006 Steering Group review
      • Half day session at 2006 mid year meetings
      • £100,000 to fund prioritization projects
    • 33. Cochrane Prioritization Projects
      • Top down vs. Bottom up
        • Call for proposals from Cochrane entities
      • Opportunity Costs
        • £100,000 from central Cochrane funds
      • Whose Priorities?
        • Up to applicant entities to decide
    • 34. Collaboration between a Cochrane Review Group and a Cochrane Field
      • Condition:
        • Hip fracture rehabilitation
      • Cochrane Entities:
        • Bone, Joint and Muscle Trauma Review Group
        • Health Care of Older People Field
      • Whose Priorities?
        • Members of the CRG and the Field
    • 35. A patient-professional partnership approach
      • Condition:
        • - Incontinence
      • Cochrane Entities:
        • Cochrane Incontinence Review Group
      • Collaborators:
        • The James Lind Alliance
        • a UK-based patient support charity
      • Whose Priorities?
        • 30 patient and professional advocacy groups
    • 36. Using practice guidelines to determine review priorities
      • Condition:
        • Eye and Vision Disorders
      • Cochrane Entities:
        • US Cochrane Centre
        • Eyes and Vision Review Group
      • Whose Priorities?
        • International clinical experts
    • 37. Prioritisation of Cochrane reviews for consumers and the public
      • Condition:
        • Any with a current Cochrane Review
      • Cochrane Entities:
        • Cochrane Consumer Network
      • Whose Priorities?
        • Consumers in low and middle income countries
      • Identify Reviews most in need of updating
    • 38. Reducing the know-do gap in low and middle income countries
      • Condition:
        • Relevant to most disadvantaged in LMICs
      • Cochrane Entities:
          • Health Equity Field
          • Health Promotion & Public Health Field
          • Developing Countries Network
          • EPOC Review Group
      • Whose Priorities?
        • Experts on health of the disadvantaged in LMICs
      • Similar methodology to HPPH group
    • 39. Conclusion
        • Prioritization is seen as desirable
        • But there are potential questions & difficulties
        • The Collaboration is proceeding deliberately
        • And hoping to learn from our experiences

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