Cochrane Collaboration
Steering Group Minutes

Minutes of the meeting of the
Cochrane Collaboration Steering Group,
Amsterdam,
10th and 12th October 1997

(Minutes approved on 14th November 1997)

Present: Zarko Alfirevic, Hilda Bastian, Lisa Bero, Cindy Farquhar, Monica Fischer, Muir Gray (Company Secretary), Gill Gyte, Cecilia Hammarquist, Jini Hetherington (minutes), Jean Jones, Paul Jones, Jos Kleijnen, Mark Lodge, Andy Oxman, Barbara Roberts (Secretariat), Beverley Shea, Chris Silagy (Chair).

1 Apologies for absence were received from Edward Dickinson. Chris thanked Cindy Farquhar, Jean Jones, and Edward Dickinson for all their hard work on behalf of the Steering Group since they had been appointed, and welcomed Paul Jones, Gill Gyte, and Mark Lodge who had been elected to replace them.

2 Matters arising from the minutes of the previous meeting (San Francisco, March 1997):

Item 4(d) - HIREx and Contact Directory: Iain Chalmers' and Philippa Middleton's paper about helping 'true blue' orphans was tabled and agreed to. One minor suggested change was to highlight the reference to the local Centre Directors being the communication link between the orphans and the Centre Directors' Sub-Group for Orphan Management and CRG Co-ordination. It was agreed that the Collaboration would always have a need for a central Contact Directory: those pieces of information come into the Parent Database and a mechanism is needed for bringing them into HIREx. Personal information on The Cochrane Library needs to be password protected, and the Software Development Group needs to be consulted if people have suggestions for additional fields or amendments to the software.

Item 4(e) - Proposal for database of unpublished data: There had been no further developments on this proposal, and Andy was asked to bring it forward to the next Steering Group meeting in Cape Town in February 1998.
Action: Andy

Item 4(h) - Guidelines on affiliate status: It was agreed that it would be important to distinguish between different types of affiliates, and to spell out the nature of the relationship in each different case. Andy was also asked to bring this forward to the Cape Town meeting.
Action: Andy

Item 4(k) - Centre Directors' Sub-Group for Orphan Management and CRG Co-ordination: Chris clarified that the sole reason for wanting to have an overview of the scopes of Collaborative Review Groups was simply to identify gaps and to help place 'orphans' into the appropriate CRG.

Item 9 - Prevention and resolution of conflicts: At the workshop held during the Amsterdam Colloquium on this, two broad types of conflict were identified: conflicts of interest, and those of interpersonal issues. As a general prevention strategy, it was agreed that we need to educate newcomers about the aims and principles of the Collaboration, to ask for transparency regarding potential conflicts of interest, and to invest more effort in team building (including a workshop on this at the next Colloquium). Consideration should be given to establishing a more formal procedure for dealing with a grievance, including training people to do this. A list was made of people who indicated an interest or who volunteered to contribute to drawing up a preliminary proposal to address this. Gill Gyte agreed to be the liaison between this group of people and the Steering Group. The suggested grievance procedure included in the Report of a Meeting of the UKCC CRG Advisory Group (June 1997, Annexe 2) should be circulated to all entities, and included in the Policy and Operations Manual.
Action: Jini, Chris

Item 10 - Monitoring progress of entities: See later item.

Item 11 - Training Methods Group: Andy explained that there is still a need for someone to take the lead of this group. At the meeting of the informal training group during the Amsterdam Colloquium, Muir Gray and Fred Wolf agreed to move this forward in the short term.
Action: Muir

3 World Tour

Chris emphasized the need to take networking and alliance developments seriously, and the role of Cochrane Centres in facilitating this process. This led to a lengthy discussion about the stability of Centres being linked to the funding provided by their host institutions. It was agreed that any change in Centre Director must be approved by the Registration Group, and the staff of that Centre should be consulted about the outcomes of any possible such change. The Registration Group should make an explicit statement to this effect, and Muir was asked to monitor this.
Action: Lisa, Muir

Verbal reports from the Steering Group's standing sub-groups

a) 1998 Colloquium Organising Group - 22nd-26th October: It was agreed to set aside a day and a half in Baltimore for the CCSG meeting, before and after the main events, to make these dates known to all other entities as soon as possible for their own planning purposes, and not to have a joint meeting with the Centre Directors unless there was more time than the one hour that had been set aside for this purpose during the current Colloquium.
Action: Jini

i) Clarification of policy re Colloquium workshops: There should be room for workshops on a wide range of topics at Colloquia, but it should be made clear to people when a particular workshop is outside the specific scope of the Collaboration. Lisa agreed to discuss suggestions made for improving next year's workshops with Kay Dickersin. Also, Jini agreed to convey to her that high quality of presentation should be insisted upon, giving guidance for achieving this, and there should be a standard evaluation form for every workshop.
Action: Lisa, Jini

b) Editorial Group:

i) Collaboration leaflet: It was agreed that Iain should be thanked for producing this very helpful leaflet with Jini.
Action: Jini

ii) Mission statement - short vs long version: It was agreed that the original 'short' version (which includes reference to 'disseminating') can continue to be used in publications. The longer version (using the words 'promoting the accessibility of') should be used in 'official' publications.

c) Executive Group:

i) Global Forum for Health Research: Chris agreed to ask Jimmy Volmink if he would be interested in participating in this group, and would like to take the lead on this. It was agreed to provide financial assistance from the Collaboration to support his travel to the meeting if necessary.
Action: Chris

ii) World Health Organisation: It was agreed that Peter G°tzsche should be congratulated for his progress in developing contacts with the European Office, and be asked to report to the Steering Group in another six months on further progress.
Action: Jini

iii) G7 initiative: Chris described the G7 group of countries project, relating to informatics and health care (Evidence and Effectiveness project). There was agreement to the Collaboration being associated with this group in some way, and Chris undertook to take this forward.
Action: Chris

d) Handbook Group: Andy reported that an updated version of this was now available, and that hard copies were being sold during the Colloquium, the proceeds of which were generously handed over later to Muir Gray for the Collaboration.

e) Publishing Policy Group:

i) Membership: Mark Lodge suggested approaching Chris Williams to see if he would be willing to become a co-opted member of this Group; this suggestion was agreed to.
Action: Mark

ii) Proposal from Vitek Tracz: Following a meeting during the Colloquium, Iain Chalmers volunteered to develop a proposal in conjunction with Vitek Tracz to establish a Collaboration journal which could incorporate Cochrane News, methodological articles and abstracts of important reviews.

iii) Written report from Update Software: This was tabled at the meeting and its contents were noted.

iv) Cochrane Reviews on the Internet: Concern was expressed that the Criticism Management System was not included in the Internet version of the CDSR. Following clarification with Mark Starr, it was clear that the plan was to include this system in future Internet-based versions of The Cochrane Library. One of the current Internet contracts was negotiated after it was agreed to include the Criticism Management System, and this contract therefore violates that agreement.
Action: Monica

v) DIALOG: There was no objection to the abstracts of Cochrane Reviews being made available anywhere at all, although each possibility needs to be discussed in detail and also its feasibility checked with Mark Starr.
Action: Monica

vi) Cochrane Field on Health Promotion: Concern had been expressed that this Field was selling their specialized register. However, on further questioning it became clear that a charge was being made for a specialized register which was a non-Cochrane product. It was agreed that it should be made clear to them that this register should not bear the Cochrane name. The Publishing Policy Group also agreed that clearer rules for 'use' of the Cochrane logo should be written down, to avoid misunderstandings about what are/are not legitimate activities of registered Cochrane entities in this respect.
Action: Muir

vii) SHINE: This is an organisation which has asked for access to The Cochrane Library to discover who accesses it, how it is used, and when. They will submit a formal detailed proposal to the PPG within the next month or so.

f) Registration Group:

i) Outstanding registration applications:

- Cochrane Cancer Network: Jean advised that she had recently written to Chris Williams saying that use of the name 'Network' for this Field had been approved by the Steering Group.

- Rehabilitation and Therapy Field: Reservations had been expressed about the proposed new name (removing the word "Physical"), which needed to be resolved, and Chris agreed to convey this to the Field Co-ordinator. After consultation it was agreed that the Field be known as the 'Rehabilitation and Related Therapies Field'.

- Multiple Sclerosis CRG: Jean advised that she was still awaiting a response from this proposed collaborative review group to the issues raised by the Steering Group.

- Consumers and Communication CRG: (Hilda left the room for this discussion, which was chaired by Andy.) This application was approved, with the strong recommendation that when the opportunity arises the separation of location of the co-ordinating editor from the RGC should be revisited.
- Drugs and Alcohol CRG: It was agreed that Jean would write to Marina Davoli saying that the details of the scope and the topics list should be better defined, a proper description of the search strategy should be provided, as well as a statement of the extent of consumer involvement, and the text of the module cleaned up, all within the next eight weeks. Jini should chase up that this is done in the specified time period; otherwise, the registration process will need to be undergone again from scratch.
Action: Jean, Jini

- HIV/AIDS CRG: Lisa asked for informal feedback from CCSG members on this draft registration application, after their return home.
Action: Everyone

- Cochrane Centre in Spain: Jean advised that she had just written to inform the applicants that their registration application had been approved.

- Cochrane Centre in Germany: This application was approved, and it was agreed that Jean should write to advise the applicants of this as soon as possible. Centre Directors should discuss among themselves the allocation of associated countries. It was agreed that in future copies of all new Centre applications should go to all Centre Directors. The form for registering a new Centre should also be amended to include the requirements to include a draft module and a list of targets as part of the application.
Action: Jean, Jini

- Skin CRG: There was insufficient time to consider this application, which should be dealt with in the normal way (i.e. by the full CCSG being given three weeks to provide their feedback to the Registration Group).
Action: Jini

ii) Checklists for monitoring progress: Draft checklists have been prepared for CRGs and MGs, but not yet for Fields. Further development of these is needed, and it was agreed that drafts of all three should be presented to the CCSG for acceptance at its meeting in Cape Town.
Action: CRG, MG and Field Reps

iii) Clarifying the message to individuals interested in forming new CRGs: This item was withdrawn as it had already been dealt with elsewhere.

iv) Possibility of a Chinese Cochrane Centre: This item was discussed at the joint meeting of CCSG and Centre Directors. It was agreed that the interested parties should be encouraged to proceed and, if necessary, to call themselves something appropriate such as the 'Chinese Cochrane Network', until such time as they meet the formal requirements for registration as a Centre.
Action: Chris

v) Proposed merger of Statistical and Standards of Reporting of Trials MGs: No objections were raised to this proposal, and Andy was asked to notify all concerned.
Action: Andy

vi) Empirical Methodological Studies MG: This proposed new Methods Group should submit an application to the Registration Group in the normal way, since it will be producing reviews.
Action: Andy

vii) Appointment of new Chair of Registration Group: Lisa agreed to chair this Group, and the three new members of the CCSG (Gill, Mark and Paul) will all join the Registration Group.

g) Software Development Group:

i) Progress on software for Criticism Management System: The results of the consultation process among entities will be reported back to the Steering Group. The web site containing the comments and criticisms will be password protected in future, and the Secretariat will apologise to entities for the fact that it had not been so protected from the outset. Monica will advise Veronica Yank to include a CRG rep on the advisory committee for the Criticism Management System.
Action: Chris, Monica

ii) Reservations expressed about RevMan by Back Group reviewers: Several points were raised in discussion of this item: (1) It was noted that some of the difficulties may be with training and the availability of workshops in some of the outlying regions; (2) Specifics regarding problems with RevMan should be sent to the RevMan discussion list, which may not have been used in this case, and therefore individuals should be encouraged to do so in future; and (3) It was pointed out that the lines of communication for such items should be directed to the Chair of the Software Development Group and/or the Chair of the Steering Group.
Action: Bev

iii) Proposed modifications to ModMan for CRGs: The recommended changes to the headings in ModMan were considered by the CCSG. An optional glossary of terms particular to a CRG could be included in the module, before the description of the Group's scope. Paul agreed to write guidelines for implementing the agreed new headings by the end of this year, consulting with the ModMan Advisory Group convenor, Kate Oldfield, to obtain the feedback recently provided by that Group, and the co-ordinating editors (particularly Jeremy Grimshaw). Cindy agreed to take forward the issue of MESh headings.
Action: Paul, Cindy

iv) Timetable for release of RevMan/ModMan: Monica described the proposed timetable for optional and mandatory releases of ModMan and RevMan over the next two years. A proposal will be presented next February to the CCSG meeting in Cape Town to outline proposed changes to the consultation process on the various issues surrounding software development, and a flow chart should eventually be included in the Policy and Operations Manual.
Action: Monica

h) Trials Registers Development Group (TRDG):

i) Correspondence with NLM: Noted.

ii) Trials Registers Development Group: Taddy reported on the activities of the TRDG in the past year. The list of handsearched journals is updated daily and kept on the Web site, but the poor response rate to the Baltimore Cochrane Center's survey means that one cannot know if people are actually searching the journals they say they are searching. Over 87,000 CTs out of 124,000 in MEDLINE have been submitted by the Collaboration. The NLM have confirmed in writing that they will incorporate non-MEDLINE citations. Everything on CCTR will eventually be accessible via MEDLINE. There are still some groups who have not contributed their specialized registers, and this requirement should be included on the monitoring checklists. Chris advised that one of the biggest concerns from the TRDG was that CENTRAL had been made part of CCTR prior to cleaning the data.
Action: CRG reps

It was agreed that Chris would encourage the formation of a CENTRAL Advisory Group, responsible to the TRDG, which is accountable to the Steering Group.
Action: Chris

5 Secretariat

i) Current financial position: Chris reported on his recent meeting with Chris Henshall (Deputy Director of the NHS Research and Development Programme, and Kent Woods, Regional Director of Research and Development for the Trent Region). It was decided that there should be a reassessment of the Collaboration's financial position in about six months' time at the CCSG meeting in Cape Town. The package of commitments and order of priority of items needing funding should be prepared for that meeting. Everyone should talk with their groups in the meantime for feedback, and bring an updated assessment to that meeting.
Action: Everyone

Logo trademarking: As the Cochrane logo trademark is registered in each particular country, this fact should be publicised to all entities.
Action: Jini

ii) AGM agenda and previous minutes: It was agreed that these were in order to table at the Annual General Meeting.

iii) Report and Financial Statements: There were no comments on these.

iv) Responsibilities of the Company Secretary: Noted.

v) Cochrane trading company: It was clarified that such a company would do whatever business the Steering Group wanted it to do. There were no objections to this in principle, but legal arrangements need to be set up for this purpose, and existing models should be looked at. Muir will provide the Executive with a formal written proposal: a name is needed, and directors.
Action: Muir

vi) The Constitution and the election procedure: It was agreed to establish a sub-committee, to consider any required amendments to the Constitution, and to produce a document clearly defining the correct procedure for running CCSG elections. Hilda, Mark and Bev volunteered to form this sub-committee, and were asked to provide written recommendations to the CCSG meeting in Cape Town.
Action: Hilda, Mark, Bev

vii) Bursary schemes for reviewers: Cecilia and Mark agreed to produce a detailed proposal on this for the February meeting, including how to administer any such scheme. Hilda and Muir will work together with Taddy regarding stipends for people from developing countries to attend Colloquia.
Action: Cecilia, Mark, Hilda, Muir

viii) Insurance for the Collaboration: Mark undertook to report back to the Executive on the position of the Collaboration's Directors, consulting with Muir.
Action: Mark

ix) Publicity via Cochrane News: All important items resulting from CCSG decisions should be forwarded to the new editor of Cochrane News, Karen Stamm, at the San Antonio Cochrane Center.
Action: Chris, Jini

6 BIOMED II Project

Discussion of the current status of this project was deferred, in view of Jos' absence from this part of the meeting.

7 CRG matters

i) Criteria for authorship: Further discussion of this should await the paper being prepared by Veronica Yank, which should be on the agenda for discussion at the Cape Town meeting.
Action: Jini

ii) Citations of individual reviews: Zarko was asked to circulate to the CCSG the proposed citation, with a proposal as to how to implement it. The CCSG would then make a decision, and convey it to the membership.
Action: Zarko

iii) Preparation of proposals in light of the Collaboration's principles: This suggestion was agreed to in principle, but detailed consideration was deferred until the next CCSG meeting in Cape Town.
Action: Jini

iv) Clarification of CCSG policy decision about reviews of diagnostic test accuracy: A proposal from the Screening and Diagnostic Tests MG to include reviews of diagnostic test accuracy in CDSR was discussed at the CCSG meeting in Oslo in August 1996. At that time it was decided not to include reviews of test accuracy in the short term (three to five years). This decision was based on a concern that the Collaboration has already taken on a large challenge preparing reviews of the effects of health care and we do not yet have adequate resources to ensure that this aim is met. Preparing reviews of test accuracy would entail widening activities within the Collaboration to address identifying studies of test accuracy, providing training and support to reviewers, and developing the necessary software. Until we are more on top of the challenge of preparing reviews of the effects of health care, taking on these and other additional challenges would not be prudent.

Meanwhile, the CCSG has encouraged the Screening and Diagnostic Tests MG to continue to develop methods for reviews of diagnostic test accuracy, to provide training and support, and to consider preparing a database of reviews of test accuracy that might be published in The Cochrane Library. Because the MG does not currently have resources to develop a database, the decision was taken not to develop a pilot database. However, it has been agreed that reviews of diagnostic test accuracy will be indexed in D.A.R.E. Members of the MG will help to ensure that reviews are registered and will work with interested CRGs to support reviewers who wish to do reviews of diagnostic test accuracy.

In the light of continuing confusion about this decision, this issue was discussed again at the CCSG meeting in Amsterdam in October 1997, where the decision taken in Oslo was reconfirmed. It was agreed to notify all registered entities of this decision, and to include something about the decision in Cochrane News.
Action: Jini, Hilda

v) Report of meeting of UK CRG Advisory Group: The CCSG asked for its thanks to be passed on to Peter Langhorne for being circulated this interesting and informative document.
Action: Jini

vi) Reviews of observational data: This item was not discussed, due to lack of time.


8 Next CCSG meeting - Cape Town

i) Bearing the costs of CCSG meetings: Everyone should recognise the implications, not only of the financial costs of these meetings but also of such costs as travel fatigue. It was agreed to extend the CCSG meeting in Cape Town by half a day to make it a full two-day meeting.

ii) CCSG contributing to SAFRICC symposium: To capitalise on the CCSG's presence in Cape Town next February, members are encouraged to consider participating, bearing in mind the cost implications of this.

9 Action Plan

This item should remain permanently on the agenda of CCSG meetings, and a column should be added to the document itself for the Cape Town meeting, to indicate progress achieved under each target. The Plan should be considered first on that agenda, rather than near the end.
Action: Jini

i) Three-year business plan - 1998 to 2000: It was agreed to bring this forward for discussion at the Cape Town meeting next February.
Action: Muir, Jini

10 Policy and Operations Manual

The contents of the draft POM were not discussed in any detail; however, it was agreed that there should be some mechanism in place by next February for editing its contents and keeping it up to date.
Action: Chris, Jini

11 Cochrane Reviews

i) Synopses: The principle of having synopses of the reviews was agreed, but with adequate quality control. In the meantime, the existing synopses should not be included in The Cochrane Library at this stage. It was agreed to see if the Applicability Methods Group (specifically David Henry and Dianne O'Connell) would work with Zarko, the Australasian Cochrane Centre and the Consumer Network to develop a process of quality control for such synopses. If they are unavailable to do this, Andy volunteered to participate instead. Mark Starr should bring to the CCSG details of the Spanish Cochrane Centre's offer to translate the entire Cochrane Library; Chris will discuss this with him, and the matter of quality control in general should be considered by the Publishing Policy Group.
Action: Zarko, Chris, Hilda, Andy

ii) Consumer summaries: This item was not discussed, due to lack of time.

iii) Quality of Cochrane Reviews: In having analysed all the Cochrane Reviews in accordance with some criteria of concern to consumers, such as coverage of adverse effects, Hilda identified a range of quality issues that gave cause for concern. These included:

- Very large differences in size, content and quality of abstracts, including inconsistencies in conclusions of abstracts compared with the full review.

- Frequent lack of consideration of adverse effects, with about a quarter of reviews being solely concerned with effectiveness, and many others barely addressing adverse effects.

- Dramatic differences in background content amongst reviews.

- Conflicting information from one review to another on the same diseases and interventions.

- Headings not adhered to, so that conclusions and implications for practice and research, for example, are often peppered throughout different sections, and not all referred to under the relevant sections.

- Often a very poor standard of expression, with extraordinarily long convoluted sentences and single paragraphs going on for more than a page.

- A very large number of typographical errors (including some which lead to confusion e.g. "others" when it should be "mothers").

- Occasionally headings with nothing under them.

- Occasionally unfinished sentences.

- Outcomes appearing on meta-analyses which are not listed in the Table of Included Studies.

- insufficient cross-referencing to other relevant and related Cochrane Reviews.

Hilda suggested that this amounted to a lack of consideration for readers, and that the editorial standard is poor in comparison with major medical journals. She identified a lack of quality control at the editorial level as a clear issue, including last-minute rushing to meet deadlines as a key factor, and too much of a push on quantity over quality. While consumer involvement was one strategy for making reviews more readable, she said that this was not visibly succeeding at this point, and a number of other strategies need to be followed as well. She argued for there to be an overall editor for The Cochrane Library; for the CCSG not to push the issue of quantity, but rather to increase its concern for quality; and that the need for editorial training for both editors and review group co-ordinators should be considered as critical.

It was agreed that Chris would write to all entities summarising these concerns, and raising the possibility of appointing a centralised copy editor, but encouraging groups to pay attention to improving the quality of their technical editing in the interim. Muir undertook to discuss these concerns with journal editors such as Richard Smith of the British Medical Journal.
Action: Chris, Muir

12 Any other business

None.



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