The Targeted Updates Project: Case Study D

The Targeted Updates Project: fourth case study

The Targeted Updates project aims to provide policy-makers, in particular guideline developers, with up-to-date information from Cochrane Reviews, tailored to their needs and working to a fast timeline. Targeted Updates use Cochrane Reviews as their foundation, but focus on updating selected comparisons and outcomes, working in close consultation with key stakeholders. In this post, the team describes their next case study. For more information, please see the blog post introducing the Targeted Updates project, the blog post describing the first case study, the second case study, and the third case study.

Case Study D: Question identified by a Guideline Developer

  1. Context

The National Blood Authority (NBA) in Australia was in the process of running a pilot to develop a more efficient and cost effective process for updating the ‘Patient Blood Management’ (PBM) guidelines. The NBA identified which parts of the guidelines were relevant to Cochrane Reviews, and this helped to inform the initial discussions regarding which topic to take forward as a Targeted Update. A review from the Injuries Cochrane Review Group (CRG) was of particular interest to the NBA. The NBA contacted Cochrane Australia to determine when there would be an update of this review. Cochrane Australia recommended that they contact the Targeted Update project team. Following initial contact, the Targeted Update team discovered that the review had been recently updated, and was ready for publication. We informed the NBA that the review was soon to be available, but they still asked the Targeted Update team to produce a Targeted Update for their question of interest. This was because (1) their question and PICO differed slightly from the full review update, and (2) they were interested in obtaining this information in a more accessible format.

  1. Process

We began by liaising with the original Cochrane Review’s author team, and by conducting an initial assessment of the latest version of the full Cochrane Review. The Co-ordinating Editor of the Injuries Group was an author on the review of interest. Therefore, he was directly engaged in the project and involved in all discussions from the start. The original review question was modified, as the NBA in this case were interested in a subgroup analysis of the results from the full review. Because the review had recently been updated and published, the Targeted Update was completed by the Targeted Update team, with content expertise from the CRG, within two weeks, and peer reviewed within another two weeks. The final output differed slightly from the standard Targeted Update template, as the NBA specifically requested the presentation of relevant forest plots. Feedback from the NBA was very positive, indicating that they would be likely to commission further Targeted Updates as part of their standard guideline updating process in the future.

  1. Output

Antifibrinolytic drugs for acute traumatic injury

  1. Feedback from the National Blood Authority

The Director of the NBA, Jen Roberts, spoke as part of the Australasian Cochrane Symposium Plenary in November 2015. During this presentation, she discussed her experience of working with the Targeted Update project, both positive and negative.

Overall, the NBA were very positive regarding their experiences.

“The targeted update was a joy to do.”

One of the main learning points they noted from their experience was the importance of setting clear PICO criteria that exactly match the research question under investigation;

“When we’re commissioning a targeted update, it’s really critical to get your PICO alignment really right, and sometimes your initial review didn’t align perfectly with a Cochrane Review.”

“That PICO alignment and the effort in that before you kick off is really important.”

They also noted some difference of opinion between the Targeted Update Team, and the clinical reference group regarding the GRADE process;

“There were some issues we’ve discovered that were in relation to editorial independence. Our clinical reference group didn’t agree with the grading of some of the outcomes using the GRADE process, and that’s now to be put to the clinical reference group in the next few weeks.”

Finally, the NBA were impressed with the speed at which the work was completed, and the high quality of the document produced by the team;

“It took about four months to negotiate the contract and about four weeks for the Cochrane Group to produce that update which was extraordinary and of really high quality.”

  1. Feedback from you

We are very interested to know what you think about these Targeted Update documents, and the project in general. We would really appreciate it if you could take just five minutes to read through and answer this short list of questions. Thank you very much for your participation!

  1. Who are the team

Targeted Update team involved in production

  • Rachel Marshall
  • Karla Soares-Weiser

Review authors

  • Ian Roberts

CRG team

  • Ian Roberts
  • Emma Sydenham
20 July 2017

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