Cochrane Collaboration
Steering Group Minutes

DRAFT Steering Group Minutes Monday 9 October 1995 Oslo, Norway

Present: Hilda Bastian, lain Chalmers, Carl Counsell, Kay Dickersin, Peter Gøtzsche, Brian Haynes, Alessandro Liberati, Andy Oxman, Dave Sackett, Chris Silagy

Apologies: Muir Gray

In attendance: Ian Fullerton Smith, Lisa Bero, Steve Goodman, Jos Kleijnen,

Gil Ramirez

Notes: Jo-Anne Henden


1. How Many Centres?

Peter Gøtzsche opened this discussion by reviewing the work of his small group at the Colloquium, the key points the group illustrated were:

a. There should be a reasonable ratio between centres and review groups, though this ratio would remain flexible as the Collaboration grows. b. There should be a contact person in each country, who would take some sort of responsibility for the development of the Cochrane Collaboration, this to be done in association with the reference Centre. C. It was considered a potential embarrassment that the cost of operating a Cochrane centre were disproportionate to the costs of operating a Review Group. d. The Group also identified that cultural differences will play a significant part in the evolution and establishment of Cochrane centres.

Overall it was believed that the Steering Group needs to structure the evolution and controlled growth of the number of Cochrane centres around the world.

The discussion broadened and Chris Silagy stated that at the Plenary Session, a suggestion had been made that Centres should be giving training and support. It was felt by many attending, that some Centres were failing to adequately provide these functions. The Steering Group then discussed how to ensure that all Centres were committed to training and providing the necessary support for the Review Groups. It was agreed that, in future, training and support of Review Groups would be a critical element of any Centre application. Any applicant not wishing to provide support and training would not be considered for registration with the Collaboration. Dave Sackett proposed that the Centre Directors prepare a paper outlining the performance criteria and functions a centre must provide, this is to be done in association with Review

Groups. The Centre Directors were asked to consider this matter further and report back to the Steering Group as a whole. Action: All Centre Directors

Alessandro Liberati enquired when the next Centre Directors meeting would be convened. Peter Gøtzsche suggested it would be beneficial to have the next Centre Directors meeting over several days and also in conjunction with the next meeting of the Steering Group. Dave Sackett suggested that we should try to identify a retreat type function that could begin with a meeting of the Centre Directors and then finish with a meeting of the Steering Group. This was expanded to be a two day Centre Directors' meeting followed by a one day meeting of the old Steering Group and the new Steering Group followed by a one day meeting of the new Steering Group. Chris Silagy enquired whether it would be possible to hold such a meeting on the West Coast of America as this would be cost efficient for the Australasian Centre. There was general approval for this as those travelling from Europe incurred a marginal increase in the cost of air fare when compared to travelling to the Eastern seaboard. Lisa Bero was tasked to find suitable accommodation and a venue. The dates of the meeting shall be as follows:

Centre Directors meeting in 1996 24 & 25 February Combined new and old Steering Group meeting 26 February New Steering Group meeting 27 February

These meetings to be held in San Francisco. Action: Lisa Bero, Ian Fullerton Smith

2. Dividing the Globe

Jos Kleijnen stated that the world was an ever changing place and that the Cochrane Collaboration should adapt to those changes. He outlined a recent suggestion that the Dutch Cochrane Centre should take responsibility for the German speaking part of Switzerland and that in time a French Cochrane Centre would take on not only the French speaking part of Switzerland but also the French speaking part of Belgium. Dave Sackett enquired whether as a general principle the Centres should decide their own geographic responsibilities and inform the Steering Group of such decisions, there was further discussion of this matter and it was resolved that the Centre Directors should make a recommendation for approval by the Steering Group. Chris Silagy urged that any geographical changes made, be communicated immediately to the Australasian Cochrane Centre to allow the Contact Directory to be updated. There being no objections, the German speaking part of Switzerland was transferred to the NLCC. Action: All Centre Directors

3. Specific Tasks for Centres

Hilda Bastian stated that there was an element of confusion about the specific tasks that each Centre was to provide, adding there is inconsistency in the information being supplied. To determine specific tasks for each Centre she had consulted three different sources of material, these being 1. minutes of Centres Steering Committees and applications, 2. information individual Centres had supplied to the Handbook, 3. peoples individual research issues. There was lack of clarity as to what exactly was the specific task being done for the Collaboration by each centre. Some Centres quoted the specialist research topic of the directors, some were quoting a local priority, and others had reclassified information such that it appeared that the Collaboration's specific task was in fact a local issue. Further discussions centred around the merits of producing national targets and making this information available to the other Cochrane centres. Dave Sackett suggested that the Centre Directors on the Steering Group should formulate a common approach and targets for submission to the rest of the Steering Group for approval. Kay Dickersin stated that in her opinion the Steering Group should make its aspirations known to the Centre Directors. Dave Sackett summarized the Steering Group's position that Centres should provide training and support for CRGs as their primary function and their secondary function should be a supporting task for the Collaboration as a whole. lain Chalmers suggested that a sensible way to codify this would be to produce a module for the Parent Database similar to that that the Cochrane Review Groups use. This will provide a standard format and structure that will make the whole process of the Centres transparent, it was proposed that lain Chalmers and Ian Fullerton Smith produce a Centre module for the Parent Database. Action: lain Chalmers, Ian Fullerton Smith

4. Non-UK Involvement in the Collaboration

Peter Gøtzsche opened this discussion by praising the work that had been done in the UK, and stressed it was important for the Collaboration to be seen as a truly international organization. He could not, however, provide any solutions to make this happen. lain Chalmers replied that he had posed some questions in a prepared paper for the meeting, these questions were directed towards Centres and were to be used as a method of self-analysis to determine how effective each Centre was in communicating with the wider community. The questions are as follows:

I . "Are you encouraging Cochranites in your countries to write commentaries and editorials in your local, general and specialist journals"?

2. "When you see that an exploratory meeting is planned, do you preemptively contact relevant Cochranites in your own country, urging them to attend and offering to advise and support them before and after the meeting"?

3. "Do you have a programme of workshops tailored specifically to support members of Cochrane CRGs to develop protocols and to use RevMan"?

4. "Do you have any workshops for training hand searchers"?

5. "Do you have any regular form of consultation with the people in your sphere of responsibility, both to find out how you can help them, and perhaps how they may be able to help you to obtain the funds to help

themselves and yourselves"?

6. "Are you making use of your Advisory Committees to come up with strategies for increasing involvement from your countries"?

lain summarized these questions saying that he felt that rather than have a concern about UK dominance it would be helpful to have a greater concern for supporting individual reviewers wherever they are in the world. Specific and focused training will help to speed the process of making the Cochrane Collaboration a truly global organization. Kay Dickersin enquired if it would be possible to collect all the various training material together and compile a Centre Handbook. lain Chalmers thought that the San Antonio Centre would be the best location to consolidate and distribute this type of information, the aim being to ensure that Cochrane training materials are delivered consistently throughout the world. Chris Silagy observed that the Australasian training programme had already identified that training is very different in different countries, and that Cochrane trainers would have to adapt their style to suit different settings and different methods of working with people. Dave Sackett summarized at this point, suggesting that it would be useful to use the San Antonio Center as a clearing house for all kinds of training materials.

The discussion broadened to encompass the international make up of any particular CRG. Chris Silagy stated that, in his opinion, the Australasian Centre would not put forward an application to register from a review group that had a low level of international involvement. lain Chalmers responded by saying there is often great difficulty in attracting international membership of new CRGs, many people had still not heard of the work of the Collaboration and this in itself proved to be a formidable obstacle. Carl Counsell stressed caution at this point. He stated that his CRG would not have passed the international criteria when first registered. However, since then, the Group has attracted more and more members from the international community. Andy Oxman believed that the Collaboration would be served better, not by attracting more international reviewers but by creating more editorial boards in countries other than the UK. Alessandro Liberati stated that this issue needs to be considered within the context of strategic planning and a realistic scenario that the growth of the Collaboration needs to be slowed down to encourage the establishment of editorial boards outside the UK. lain Chalmers supported this view stating that it was his preference that there should be more editorial bases outside the UK. Hilda Bastian suggested that, as a mechanism to encourage internationalization, editorial boards should be prepared to move location every three to five years. Carl Counsel[ disagreed with this proposition on the grounds that the investment in time and training and expertise gained by the Administrators of CRGs would be lost. lain Chalmers supported this, stressing that the difficulties encountered by the Pregnancy and Childbirth Group in moving its editorial base had been traumatic and disruptive. Jos Kleijnen believed that it was more important to have more CRGs created quickly irrespective of their location as the world had an expectation about the work of the Collaboration. Dave Sackett summarized the discussion: there appeared to be a consensus among the members of the Steering Group that the creation of CRGs was more important than the location of their editorial bases, and each Centre would use its best endeavours to locate editorial bases across the world. Action: All Centre Directors

S. Strategic Planning

Peter Gøtzsche opened this discussion by saying that he felt that the whole of the Steering Group agreed that this was an extremely important item. Andy Oxman stated that it should be an objective of this meeting to devise an agenda and plan with a time line that will allow a full discussion between all the Entities. Chris Silagy asked whether this process should be externally facilitated using an organizational consultant. Although there was some discussion around this item, nothing was concluded. It was suggested that strategic planning should be on the agenda for the meeting in February. Alessandro Liberati made the comment that if we attempted to do such a thing we would end up with a crowded agenda and nothing would be resolved in the time available. After much discussion it was decided that there would be a consultation process throughout the Collaboration. This would involve drawing together information from three different sources, these are as follows:

a. From the members of the Steering Group and the Centre Directors b. From the registered Entities namely the CRGs, Methods Groups and Fields C. From the information gleaned at the Plenary Sessions during the Oslo Colloquium

A working group was suggested to handle this information and to put out requests to the registered Entities. This group comprises [an Fullerton Smith, Carl Counsel[, Hilda Bastian and Andy Oxman. The time lines are as follows: contributions from everyone to be received by the Working Group by November 17, this information will be consolidated and presented to the Steering Group by December 1. Thereafter volunteers are required to draft discussion papers for circulation to the Steering Group by January 15 1996. The object of this exercise is not to formally draft a strategic plan, but rather to gather the information together to enable the new Steering Group to commence the strategic planning process. Action: Ian Fullerton Smith, Carl Counsell, Hilda Bastian, Andy Oxman

6. Handsearching General Journals

Carl Counsel[ stated that when examining the Annual Report it became apparent that many of the Review Groups had insufficient access to the many different registers of trials that were being compiled within the Collaboration. It was a concern that when searching MEDLINE the results produced could not be predicted. Dave Sackett suggested that information on new trials that had been sent forward to Baltimore but had not yet been included in the NLM be displayed using the Internet. lain Chalmers stated that it was his intention to consolidate all the pre 1966 journal searchers and letters plus the ten general medical journals which the UK Centre searches onto a database of some form, a disk copy of which would be made available to the Review Groups. Kay Dickersin agreed that this idea had some merits though she was concerned that an element of confusion may be introduced. The Nordic Cochrane Centre reported that their policy is to keep a photocopy of every trial that they find. This gives them the ability to send a single copy to a Reviewer on request. Using this system a Reviewer has to discover from some information point or other whether the journal has been searched, this could be a local Cochrane centre, the Internet, or the Baltimore Cochrane Center. A discussion broadened and examined the pros and cons of setting up an alternative database system to the NLM, though at this time no firm conclusion was reached. It was decided that a discussion paper be produced, the format being that anyone on the Steering Group can nominate an idea to Ian Fullerton Smith who will collate and disseminate to the rest of the Steering Group. Thereafter it would be up to an individual or group of individuals to write and disseminate any further discussion papers on this subject. Action: Steering Group

7. Notification of Intent to hold Exploratory Meetings

lain Chalmers raised concerns that at present there is a lack of a formal mechanism by which informal exploratory and full exploratory meetings are notified to the Collaboration. He suggested that a consultative process be established whereby Ian Fullerton Smith could receive guidance as to when a meeting was considered a full exploratory meeting. This should help the Collaboration move away from some of the arbitrary decisions that have been made in the past. Communicating the date of a meeting to those parties interested in the Collaboration has not always been successful. There have been a combination of reasons why exploratory meetings have failed to be as effective as they can be and this is often related to short time scales and the failure to notify all of those who may have an interest in the subject. Chris Silagy suggested that the new single Directory would help to alleviate many of these problems. This database should give multiple descriptions of a persons interests, whether or not he or she is currently involved in a Review Group. The searchable nature of the new database system will allow everyone in the Collaboration who has expressed an interest in a given subject area the opportunity to be contacted with regard to an exploratory meeting for a proposed new group. The technology of the database and the information it holds will help to remove any subjectiveness regarding the eligibility of notification of those persons who are thought to be interested in a given subject area. There was further discussion on this subject and it was concluded that, at this stage, it would be each Centre Directors responsibility to notify Ian Fullerton Smith of any meetings relating to potential or registered entities. Notification must be given on informal exploratory meetings, formal exploratory meetings and open review meetings of established groups. Dave Sackett suggested at this point that an individual or group of individuals from the Steering Group may wish to prepare a discussion paper. Action: All Centre Directors

8. Peer Review and Quality Control

Lisa Bero was originally to discuss a proposed mechanism for peer review before and after systematic reviews had been entered into CDSR. She further commented that, at this time, peer review may be too narrow a focus. Perhaps the work of the San Francisco Center should be expanded to cover quality control of all the elements of a Cochrane systematic reviews. Andy Oxman stated that there were 16 different ways that the Collaboration had tried to ensure that quality was built into the systematic review process and that it would be a mistake to apply the principles of quality control only to peer review. lain Chalmers proposed that a major challenge for the San Francisco Center was to capture and disseminate, the external worlds reactions to the Cochrane reviews after they had been published on the Database. Dave Sackett proposed that Lisa Bero and Drummond Rennie should prepare a discussion paper - or circulation to the Review Groups. This paper would outline the mechanism and the objectives of applying quality control to the work of systematic reviews. The Review Groups would be asked to comment and give feedback, and the results of this consultation exercise would then be circulated to the Steering Group for further discussion. Peter Gøtzsche enquired whether the Peer Review Group would make recommendations about the use of terminology within the Cochrane Collaboration. It was noted that concerns had been raised at the previous day's general meeting that there was far too much terminology used and it was confusing many members. Action: Lisa Bero, Drummond Rennie

9. Common Curricula for Training

Dave Sackett enquired whether this was any longer an issue. There was a consensus that this subject had already been covered in previous discussions. The item was passed over.

At this stage of the proceedings it was decided to prioritise the subjects remaining that the Steering Group needed to cover, these were as follows:

1. The composition of the Steering Group 2. The election process 3. Negotiations regarding an Internet contract (a) Do we go with Synapse Publishing or (b) put out a request for proposals to other interested parties 4. Dealing with established Review Groups and how we approach them 5. Annual meetings

At this point the Steering Group departed from the formal agenda and decided to revisit the recently listed items.

1. Composition of the Steering Group

Andy Oxman stated that, though in favour of a position for a policy maker, he felt at this time that the role of the position had not been thought through thoroughly, and would be pleased if the Steering Group considered the matter further. It was proposed that, in the short term, instead of electing a policy maker, it would be possible to coopt a representative from the policy making community. The Steering Group decided at this point to defer the matter until the new Steering Group had been formed.

At this point a special meeting was convened by the majority of the Steering Group. Dave Sackett, Ian Fullerton Smith and Jo-Anne Hendon were asked to leave the meeting for a brief period.

The formal Steering Group meeting re-convened and the provisional agenda was revisited and re-prioritised.

1. Follow up Discussions on Minuted Items

Andy Oxman led the discussion about the mechanism for following up the minuted decisions of the Steering Group. It was proposed that issues could be discussed on the CCSG mail list or by arranging conference calls between the members of the Steering Group. Dave Sackett suggested that a possible way forward was to task two or three members of the Steering Group with responsibility for a particular item, and encourage them to develop discussion or policy papers for the rest of the Steering Group to consider. Action: Steering Group

2. The Role of the Executive Officer

Kay Dickersin enquired why the role of the Executive Officer was in question. Iain Chalmers replied that it was his opinion that the Executive Officer should receive some guidance from the Steering Group as to the extent of his responsibilities and duties. A general discussion followed and many facets of the Executive Officer's job were explored. Dave Sackett asked the Executive Officer to prepare a view graph job description for submission to the Steering Group, Brian Haynes asked that the job description should outline the Executive Officer's personal view of the role. Action: Ian Fullerton Smith

3. Registry of Trials

Kay Dickersin opened this section by explaining the serious funding difficulties that the Baltimore Cochrane Center was experiencing. It appeared that some short term funding was available, though this would only pay for 10% of the administrative salary budget. Ian Fullerton Smith asked for an estimate of how much it would cost to operate the Baltimore Cochrane Center on an annual basis. Kay Dickersin estimated at least $200,000. Various options were explored as to how the Collaboration could raise this finance, it was suggested that subscription fees could be used and that the Baltimore Cochrane Center could take on contract work from various US funding agencies. Peter Gøtzsche suggested that each Cochrane centre pay an annual levy towards the Baltimore operation, approximately E30,000 a year was suggested. However, this was felt to be unrealistic in the short term. Chris Silagy suggested that we develop a fall back situation whereby each Cochrane Centre could take some of the work currently done by the Baltimore Center to ease the load. This would also mean that if the Baltimore Center had to close due to lack of funding the work of the trials register could continue in many locations rather than one. Kay Dickersin was requested to keep the Steering Group informed of her current financial situation. It may be appropriate to arrange a conference call prior to the next Steering Group meeting so that each Steering Group member has a clear picture of the current situation. Andy Oxman suggested four strategies to help to improve the situation.

1 . Kay Dickersin and Ian Fullerton Smith to work together and explore the potential with contracting with MetaWorks; or a similar organization to find a new home for the trials registry.

2. Any funds coming into the Collaboration could be diverted to Baltimore as a priority.

3. Some Cochrane centres may be able to channel fund to the Baltimore Center, providing the Baltimore Center raises an invoice for services.

4. Encourage each review group to contract with the Baltimore Center for the purpose of building specialized trial registers.

5. Chris Silagy suggested that part of the registration fee for the Adelaide Colloquium could be diverted towards the Baltimore Cochrane Center. Kay Dickersin supported the suggestion that review groups which are developing specialized registers should contact their local centre to enter their information into ProCite. This would form the basis of a varied solution should the Baltimore center have to close. Action: Kay Dickersin, Ian Fullerton Smith

4. Internet and Synapse Publishing

Brian Haynes suggested that it would be appropriate to decide at this time whether the Steering Group should opt for a contract with Synapse Publishing or alternatively seek requests for proposals from other Internet providers. Andy Oxman believed that it would be proper to move ahead with Synapse Publishing. lain Chalmers supported this motion providing that a non-exclusive contract could be negotiated. Ian Fullerton Smith was asked to negotiate a draft contract with Andrew Penn and circulate that draft to the Steering Group and the Informatics Group for comment. Action: Ian Fullerton Smith

5. Future Colloquia

Ian Fullerton Smith opened this by saying that he had been approached by a representative from India enquiring whether a Colloquium could be held on the sub- continent in 1997 or 1998. The Steering Group considered this and were concerned about the finances of such an operation. Chris Silagy said that in terms of logistics it would be very difficult to organize Colloquium in India particularly since there is no Cochrane center in India and the burden for organization may well fall on the Australasian Cochrane Centre. Ian Fullerton Smith was asked to convey this message to Dr Kameshwar Prasad. A discussion took place as to whether the Baltimore Cochrane Center could hold the 1997 event. This was very much in doubt due to the present funding situation. Jos Kleijnen had reported that Dr Wayne Jonas of the Office of Alternative Medicine had indicated that he may have funds to support a Cochrane Colloquium in the Baltimore area. This would have to be fully discussed with Kay Dickersin. There was debate about how the profit, if any, of any future Colloquia should be spent. Should these funds be retained within the country or given to the Collaboration. Chris Silagy requested explicit guidance from the Steering Group on how to deal with the stipends issue. It was reported that Jos Kleijnen had made a provisional offer to hold a Colloquium in 1998, though if the plans for Baltimore failed it might still be possible to organize something in 1997 in Amsterdam. A discussion returned to whether the Baltimore Cochrane Center could host the 1997 Colloquium and it was decided that Kay Dickersin should pursue the offer of funding from Wayne Jonas. Action: Kay Dickersin, Ian Fullerton Smith

6. Elections

The Steering Group revisited the decisions made earlier in the Colloquium regarding the constitution of the new Steering Group. There was discussion around the make up of the Centres constitution and representatives. Concern was expressed that the fourth place allocated to a member of centre staff may not be filled. Peter Gøtzsche enquired whether the Centre Directors should have an automatic right to three places, rather it should be four representatives of Centres one of whom would not be a Director. This idea did not receive the approval of the Steering Group. It was decided to leave the composition of the Steering Group as previously decided. Action: Ian Fullerton Smith

7. Future Software Development

Brian Haynes was anxious that the declaration by lain Chalmers that the UK Cochrane Centre would cease funding software development by the end of 1996 would cause major problems for the Collaboration. He suggested that a search begins for a new contractor and new sources of funding and volunteered the Informatics Group to carry out this process. Andy Oxman stated that in his opinion that it was the role of the Software Development Group to determine firstly future software requirements and secondly the strategy for achieving those aims. The Nordic Cochrane Centre will take responsibility for part of the software programme in the near future this should ease the burden on the UK Cochrane Centre. This was agreed by the Steering Group. It was agreed by the Steering Group that the Software Development needs of the Collaboration should be prioritized and that funds should be sought from whatever source to achieve the development of these products. Action: Software Development Group, Ian Fullerton Smith

Meeting closed 1600 hrs.

A list of items not discussed due to lack of time

a. Fees b. North American strategy c. Methods to ensure that Methods Groups respond to CRGs d. The Annual Report e. An Internet mirror site f. Dealing with imposters g. Review group operating guidelines

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