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Sustainability & Cochrane Reviews How technology can helpChris MavergamesDirector of Web DevelopmentThe Cochrane Collaboration
Structure of this talk• Sustainability of Review production (internal sustainability) ▫ Technologies to assist Review production ▫ PICOtron and Overviews of Reviews• Sustainability in the health information marketplace (external sustainability) ▫ “Nimble” content and thinking outside Review “container” ▫ Linked data and Star Trek• Summary
Information Technology Strategy“Information and Communication Technology (ICT) is at the heart of The Cochrane Collaboration ... To a very large extent, the success of The Cochrane Collaboration has been based on its investment in ICT.” - From the Collaboration‟s information technology strategy paper (ISSF)Our data and systems are great, but...
Some critical points• For internal processes ▫ How to automate w/o creating more work ▫ Important that methodology remains sound• For external consumers ▫ Retain context of findings and results ▫ Create better understanding, not confusion
Sustainability ofReview production (and updating)
Producing Reviews - challenges• We have this incredibly complex, methodologically rigorous process and aim to be global and comprehensive with a mostly-volunteer workforce• We‟ve just cleared 5,000 reviews and its taken nearly 20 years, and these need to be maintained and updated• Estimates say we need min. 10,000 Reviews to be comprehensive (estimate 10 years old!)
Cochrane Reviews are fantasticbut...• …creating them is a long and laborious process
Cochrane Reviews are fantasticbut...• …creating them is a long and laborious process Help!
Review production assistance• Reference managers ▫ EndNote, Zotero, Connotea, Mendeley and others• Screening/appraising references ▫ ScreenToGo App (email: firstname.lastname@example.org for public beta)• Automated abstract screening/appraisal ▫ Semi-automated appraisal Support Vector Machines (SVMs) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824679/• Software covering multiple steps in systematic review production ▫ EPPI-Reviewer (http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=1913) ▫ Distiller SR (http://systematic-review.net/) ▫ EROS (Early Review Organizing Software http://rs.iecs.org.ar/) ▫ Automated data extraction from Cochrane Reviews (reading the XML)• GRADEpro• CRS Slide courtesy: Rachel Marshall
What if authors could...?• Pull in Risk of Bias assessment information already done on trials or studies• See studies already included or excluded in other Reviews• Other links between studies and Reviews via the CRS – more later in Star Trek section• Use datasets like Drugbank and Diseasome for auto-completion or help filling out fields in RevMan for standardisation
Could we use technology to assistwith…?• Using MeSH mappings to show coverage of Reviews• Using study links to show where gaps exist• Priority-setting• Creating derivative “views” or products from Cochrane data
PICOtron and Cochrane ClinicalAnswers• Project to semi-automate populating Cochrane Clinical Answers, a derivative product of The Cochrane Library• Python script written by Iain Marshall that extracts data from Cochrane Reviews• Script automatically and randomly reconfigures Review titles into one of 30 question formats
PICOtron• Data is pulled from various areas of the Review XML• Depending on whether the result is significant and favored intervention, a sentence (narrative result per PICO) explaining these results is automatically generated• Then, an author checks these and combines this information across PICOs into a “clinical answer“
Help in preparing of Overviews of Reviewsand Network Meta-analysis driven by linked data Image from Lorne Becker
Example of a trial level paroxetine synthesis sertraline citalopram 12 new generation escitalopram fluoxetine antidepressants: fluvoxamine Which ones are the milnacipran most efficacious? venlafaxine reboxetine bupropion mirtazapine duloxetineThanks to Georgia Salanti. Source: http://cmimg.cochrane.org/workshops-19th-cochrane-colloquium-october-2011
Network of Randomized Trials sertraline milnacipran reboxetine No trials paroxetine comparing mirtazapine reboxetine to bupropion duloxetine ? available in Cochrane Reviews fluvoxamine escitalopram citalopram bupropion venlafaxine fluoxetineThanks to Georgia Salanti. Source: http://cmimg.cochrane.org/workshops-19th-cochrane-colloquium-october-2011
Other ideas?Perhaps we can gain insight into how toimprove Review production processes fromhow our users actually use our output? segue ...
Sustainability in the health information marketplace
“The problem is not information overload but filter failure.” – Clay Shirky• Cochrane provides a vital curation, filtering and evaluation/quality-assessment role and we need to make this clear
Again, Cochrane Reviews arefantastic BUT...• There are problems that limit their use by some people ▫ Difficult to wade through all of the text ▫ Difficult to understand the figures, terminology, and other bits of the Review ▫ Hard to compare interventions without reading multiple Reviews ▫ Moving from studies in CENTRAL to Reviews that included that study difficult ▫ Can be difficult to find the Review you seek
• Search for “Prozac” – no reviews• Search for “fluoxetine” – 27 reviewsSearching The Cochrane Library
Ideally, we‟d restructure ourcontent for different users• Beginning to do this now: ▫ Summaries.Cochrane.org for consumers ▫ Cochrane Clinical Answers for clinicians• BUT ▫ Takes a lot of work to reformulate reviews & authors, CRGs, etc are busyWouldn‟t it be nice if we could automate or semi-automate some of these processes?
Machines aren„t good at readingweb pages• Data on the web is meant for human consumption• Machines need the data to be structured• Once structured, information can be more easily shared within datasets and across web pages
It„s about...• Taking the complex relationships, interactions and dependencies in our data and modeling them in semantic web language and concepts for machine processing...• So that we can do things like: ▫ Gain insights into our data ▫ Help with priority setting ▫ Repackage it for different users ▫ Later, perhaps machine can infer new knowledge from our data and/or when our data is combined with other datasets
CRS and CENTRAL• Lack of unique study IDs a real problem• CRS solves this by providing a unique ID for all studies that can be referenced• Better linking of data about trials and to Reviews ▫ Example: Using forest plots to generate related studies lists for CENTRAL• Possibilities with linking to external sources such as PubMed
We can…• Ask questions that use data from several different reviews• Improve search• Make it easier for people to find Cochrane Reviews• Link data from studies and Reviews better• Enhance the experience of our users by including data from other datasets
A question using multiple reviews I’ve done a search for trials on a particular intervention for dementia. I want to know which of the trials have been included in a Cochrane Review and a summary of the risks of bias for the entire set of trials.
Links to the relevant Review forthose trials that were included
This study was one of 38 studies included in the Cochrane Review, <Title Here>. Click here to see the full reviewLinks to the relevant Review forthose trials that were included
RoB Summary for Cochrane Reviews ondementia These figures summarize Risks of Bias from the trials included in the reviews in your search
Enhancing the User Experience Make search work better
You Say “Paracetamol”I Say “Acetaminophen”• Or, one could say any of these:Abenol (CA), Acephen, AnadinParacetamol (UK), Apo-Acetaminophen (CA), Aspirin Free Anacin, Atasol (CA), Calpol (UK), Cetaphen, Childrens Tylenol Soft Chews, Disprol (UK), Exdol (CA), Feverall, Galpamol (UK), Genapap, Genebs, Infants Pain Reliever, Mandanol (UK), Nortemp, Pain Eze, Panadol (UK), Robigesic (CA), Silapap, Tycolene, Tylenol 8 Hour, Tylenol, Tylenol Arthritis, Uni- Ace, Valorin
Summary• Technology IS at the heart of what we do• For both internal and external applications, we can leverage these tools to further our mission• Requires that we think differently about the “container“ of the Review• Our data needs to become “nimble“ to meet future user needs• We should proceed slowly, incrementally - What are the “quick wins“?• Cochrane has the chance to lead in Web 3.0