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| MEDICINE AND SOCIETY |
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| Year : 2023 | Volume
: 4
| Issue : 1 | Page : 68-70 |
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Cochrane India and evidence synthesis
Meenu Singh, Anju Pradhan
Cochrane India, AIIMS, Rishikesh, Uttarakhand, India
| Date of Submission | 13-Mar-2023 |
| Date of Decision | 20-Mar-2023 |
| Date of Acceptance | 23-Mar-2023 |
| Date of Web Publication | 26-Apr-2023 |
Correspondence Address:
Dr. Meenu Singh
AIIMS, Rishikesh - 249 023, Uttarakhand
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JME.JME_36_23
How to cite this article:
Singh M, Pradhan A. Cochrane India and evidence synthesis. J Med Evid 2023;4:68-70 |
Cochrane is an international charity setup to promote evidence-based medicine (EBM). Since its inception nearly 30 years back this organisation has met the challenge of making vast amounts of research evidence useful for informed decision-making about health. The core activity of thousands of researchers associated with Cochrane is synthesising research findings by doing quality systematic reviews called Cochrane Reviews. This work has been recognised as the international gold standard for high quality, trusted information. Named after Archie Cochrane, the British epidemiologist, it has led to an international revolution in evidence-based practice.[1]
Cochrane's strength is in its global collaborative community. There are more than 110,000 members and supporters from more than 220 countries associated with the Cochrane collaboration. All the constituents are united by a single passion to develop and popularise evidence-based practice.
The term EBM was coined by a group of epidemiologists led by David Sackett and Gordon Guyatt from McMaster University. EBM is defined as 'the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients'. The practice of EBM means integrating individual clinical experience with the best available external clinical evidence from systematic research.[2]
The science of EBM is still in its infancy in India. The Indian Council of Medical Research (ICMR) has promoted EBM in India by funding an Advanced Centre for EBM (2007–2011) that hosted the South Asian Cochrane Network and Center at the Christian Medical College, Vellore.[3],[4] An internal review of the Cochrane structure carried out in 2016 revealed that a single-center approach is less efficient in the large continents. Hence, in 2021, a Cochrane India network was launched after a planning meeting in February 2020. The network consists of nine affiliate centres, located at premier Indian institutions, that are following actively the Cochrane philosophy. This network is popularly known as Cochrane India with focus on increasing the use of Cochrane's evidence in knowledge translation and policy-making activities. The affiliate centres promote and represent Cochrane in particular regions/area of the country. The Cochrane India network attracts and supports larger numbers of India-based authors, methodologists and editors with requisite knowledge and expertise.
There had been several centres pursuing the conduct of Cochrane reviews in the past, a few of them have joined the Cochrane India Network. An introductory meeting of the Network was held on 14 April 2021 with the formal introduction of the teams of the network, introduction to the strategic plans and modalities of functioning. The formal inauguration of the Cochrane India Network (CIN) took place on 26 November 2021 with the participation of members from the Cochrane, WHO, Government of India, and the D. G. ICMR. Each of the nine affiliates has formalised a memorandum of understanding with Cochrane. Regular meetings with the Cochrane Central Executive member are held to discuss the procedures and activities of the network. The objectives for the nine affiliate centres are: (1) To promote Cochrane and its work in India, (2) To support and develop the community of Cochrane members in India and (3) To disseminate Cochrane systematic reviews locally based on stakeholder network, the media and other communication channels. In addition, an affiliate may decide to take up functions of associate centres and full centers, but there is no obligation to do so in the present phase.
| The Strategy for Change | |  |
At present, the Cochrane is undergoing transformative changes in its infrastructure according to the Cochrane's Strategy for Change. The Future of Evidence Synthesis is a critical programme of work for Cochrane over the next 3–5 years.[5] Moving away from the long-standing structure of 52 review groups, 24 satellites, fields, methods and consumer groups, the new streamlined structure will consist of:
- Evidence Synthesis Units (ESUs) located in both high-, Low- and Middle-income countries (LMICs)
- Thematic Groups focused on global priorities and editorial processes for evidence syntheses, knowledge translation and stakeholder engagement
- A Central Editorial Service that handles the editorial process for all evidence syntheses published in the Cochrane Library, including a direct pathway and a fast-track service, to strengthen consistency and delivery.[5]
The objectives for change are to deliver directly on the goals. The enabling objectives are: improved efficiency, sustainability, increased awareness and impact and enhanced accountability. Successful delivery is essential for Cochrane's future and sustainability. Moving towards an open access business model for Cochrane, an affordable model is being envisaged for improving the timelines of production of reviews and making it more effective. This is expected to attract high-quality reviews and authors. A fast-track service for high profile reviews is also being thought about. The new pathways for submitting reviews to the central coordinating unit are envisioned. A core component of the new production model is the creation of Cochrane ESUs and Thematic Groups. The structure of 52 specialty-wise Cochrane Review Groups (CRGs) are going to be replaced by the larger ESUs. This role will work closely with the Head of Change Management, to create, launch and manage the initial application process for ESUs and a second application round for Thematic Groups and help to manage the initial stages of the pilots. The distribution of ESU across the globe would be geographically diverse with at least two such units located in the LMICs. Besides having an experienced and skilled leader, each ESU would have a core team with expertise in information sciences, methodologists, statisticians and reviewers. There would be terms of reference laid out for the ESU, they would be expected to project their yearly plans. Ten targeted projects on the simplification of systems, processes, and tools will also benefit Cochrane's systems and processes, and develop tools to enhance efficiency in the production of evidence synthesis. There is a need identified to streamline the review development and publishing processes. Shortening the review format is key to making reviews easier to write and access. This will also make Cochrane a more attractive publication option, improve the author experience, and streamline editorial processes and copy editing. Production costs will be reduced in the longer term, and Cochrane will be better placed diversify its evidence synthesis types and make content more accessible.[6]
Cochrane Methods and Consumer Groups have an ongoing role in the new model. Review Groups, fields and geographic groups with stable funding are continuing to operate throughout the transition period and will have time over the next 3–5 years to consider if, when and how they'll evolve as part of the new model. Some groups may become 'early adopters' through the Thematic Group pilots or potentially explore the option of setting up a Cochrane ESU in their region [Figure 1].
By instituting these changes the Cochrane hopes to support and lead the world in the area of evidence synthesis supporting a world of better health. The means to do this is through engagement with multiple stakeholders for ideas, innovation, workshops for ideas and community engagement.
The current transformative phase of the Cochrane provides immense opportunities globally and specifically to LMICs to contribute and become part of the new evolving Cochrane. As such, being a global network, stakeholder engagement, community engagement is the way forward for the Cochrane and its Geographic Groups and this has been endorsed by the new leaders at the Cochrane. The financial challenges being faced by the Cochrane at this time are enormous: from March 2023 there has been a curtailment in infrastructure funding,[7] the UK-based national funders want assurance in the timeliness of review production and prefer to have a choice in the selection of topics they consider important. It has been realised that Cochrane's reputation alone is no longer sufficient in the context of funding constraints. However, these challenges also open doors for global participation, proposals from self-sufficient organisations that can vouch for sustainability would be welcome as the new face of Cochrane. At this time point, efficient organisations from India with a track record in evidence synthesis, who are part of the Cochrane India Network in the country can propose their centres as one of the 10 new ESUs and 12 thematic groups. It is known that a large proportion of Cochrane contributors in the past have been from the developed countries. Except for the reviews produced by the Cochrane Infectious diseases group, the topics addressed as reviews by the majority of the CRGs pertained to the health priorities of the developed nations to a large extent. The information about systematic reviews addressing problems of LMIC is scant.[8] Addressing the health topics of priority in the developing countries through Cochrane systematic reviews is a long-pending task, concurred by the stakeholders. A survey of six CRGs in 2018 revealed that out of 669 reviews in only 122 (18%) the corresponding authors were from LMICs (18.2%) reviews and 22.3% of included trials had been conducted in developing countries.[4]
| Priorities in CIN | | |
As a network, the CIN needs to work in the areas on national priorities. With the collaborations with the National Institution for Transforming India (NITI) Aayog, the network is already contributing in this direction. Systematic review topics have been assigned by the NITI Aayog and work is in progress to help answer some critical questions of the national programmes.
| Strengthen CIN Representation | | |
The CIN needs to strengthen its representation by involving more institution in its network who are not yet partnering with CIN. Interests have been received from a couple of institutions to be considered once the network stabilises. It is, however, a challenge to consider individuals interested in joining the network without institutional support; same is the case when academic societies approach the network with interest in joining it.
| Support for Authors | | |
One of the objectives of the CIN network is capacity building. The member affiliate centres of the CIN are regularly organising capacity building workshops which are advertised on the website in advance. In addition, the participants of workshops are followed up, handheld to help resolve any difficulty faced by them in review completion.
| Make Evidence Available to All | | |
Translating the Cochrane reviews and disseminating the findings to the stakeholders using various mediums is underway as one of the activities of the network. At present, there is a lot of scope for knowledge brokering – A strategy to close the 'know-do gap' to promote evidence.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Shah HM, Chung KC. Archie Cochrane and his vision for evidence-based medicine. Plast Reconstr Surg 2009;124:982-8.  |
| 2. | Sackett DL, Rosenberg WM, Gray JM, Haynes RB, Richardson WS. Evidence based medicine. BMJ Br Med J 1996;313:170. |
| 3. | Indian Council of Medical Research. ICMR Strategic Plan and Agenda 2030 Transforming Health of Indian People through Responsive Research. New Delhi: Indian Council of Medical Research; 2017. |
| 4. | Sinha A, Shah D, Tharyan P. Building capacity of Indian scientists to conduct systematic reviews in child health: An ICMR initiative. Indian Pediatr 2015;52:195-8. |
| 5. | Cochrane. Future Cochrane: A New Model for Delivering Global Evidence. UK: Cochrane; 2022. Available from: https://futurecochrane.org. [Last accessed on 2023 Mar 10]. |
| 6. | |
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| 8. | Sinha A, Ovelman C, Pradhan A, Gupta N, Thumburu K, Gupta P. Profile of published Cochrane systematic reviews in child health from low- and middle-income countries. Indian Pediatr 2019;56:45-8. |
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