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 first case study. For more information, please see the blog post introducing the Targeted Updates project.

Case Study A: Question identified in partnership with a Guideline Developer

1. Context
One of the first groups we worked with was the Skin Cochrane Review Group (CRG). We liaised with this CRG to identify priority topics for a Targeted Update (TU), based on their existing relationships with guidelines developers. Following consultation with these guideline developers, the CRG returned to us and suggested a number of topics that could be suitable for a TU. It was agreed that we would proceed with three of these topics: two produced by the TU team, and one produced by the CRG.

2. Process
We agreed the questions among the CRG, guideline developers, and the TU team. We began this process by liaising with the original Cochrane Review’s author team, who informed us that they were interested in beginning the process of updating the full review, and by conducting an initial assessment of the latest version of the full Cochrane Review. The CRG completed all tasks for one of the TUs internally, with guidance from the TU team. The TU team completed all tasks for two of the TUs, with content expertise from the CRG. The process of producing and peer reviewing these documents took much longer than expected. The first drafts of all three TUs were produced and ready for peer review within four months; the peer review of these documents was completed a further two months later.

3. Output
Targeted Updates led by TU team
Oral propranolol for infantile haemangioma

Topical timolol for infantile haemangioma

Targeted Update led by the CRG
Interventions for cutaneous sporotrichosis

4. Feedback from the Skin CRG
We asked the members of the Skin Group Editorial Team for some feedback on their experiences with the TU process, both positive and negative.

The team were pleased with the overall presentation of the final product, although they noted some areas in which improvements could still be made.

“I really liked the final product as it was easy to read in one bite. I had to check it over carefully though in order to get the messages and context right.”

“Could you have a separate section for quality assessment? I think the outcomes need stating clearly – you have to dig for them in the results and in the purple text on the 2^nd page.”

“As a reader I think they are refreshingly clear and easy to understand, and the brevity is very welcome.”

One of the predominant disappointments experienced by the Skin CRG related to how long the entire process took, in comparison to what they had been told to expect.

“I was disappointed about the time lag from completion of the TUs to publication, although I understand this may be due to this being a pilot.”

“I think originally the imposition of the tight timescale made it difficult to get started as it felt we had to drop everything to get these completed within weeks. So this timescale seemed to be totally unrealistic.”

The team were also disappointed that the documents have yet to be made publically available.

“The fact that they are still not published in the public domain has completely defeated the purpose of doing them. I realise this will not be the case in the future.”

The Skin CRG were offered some monetary incentive to help complete the process. Overall, they seemed to find this a fair incentive.

“The funding seemed very fair to me. If we had that level of funding to employ systematic review help for other reviews, it would make a huge difference to us.”

We had hoped that sharing the updated searches with the group might also be a benefit for the group, but this may not have been the case.

“Not sure how valuable the search results were as we could probably handle that ourselves comfortably.”

“For me the process has been much as it would be for any other review as I have run the same searches I would have for a full review.  However, I’ve only had to run them once before publication of the finished product, rather than up to 4 or 5 times with our standard reviews, so that has felt very efficient.”

Overall, the team appreciated that, while the process may still have some issues to iron out, the overall concept is a good one that has its benefits and potential.

“As a concept of how to update a big review by concentrating on the most important points of comparison it has potential.”

“It’s been a good catalyst for teams to get going on their full updates. I also think it facilitated more team thought into the topic area than there might have been if they’d gone ahead and began the update straightaway.”

5. Feedback from you
We are very interested to know what you think about these TU documents, and the project in general. We would really appreciate it if you could take just 5 minutes to read through and answer this short list of questions. Thank you very much for your participation!

6. Who are the team

Targeted Update team involved in production:

• Rosie Asher
• Hanna Bergman
• Antonio Grande
• Dennis Kahn
• Rachel Marshall

Cochrane Review Authors:

• Interventions for infantile haemangiomas
  • Monica Paola Novoa
  • Ingrid Arevalo-Rodriguez
  • Lucia Giraldo
  • Sandra Beltran
  • Eulalia Baselga
  • Ali Shahbaz
• Interventions for the treatment of sporotrichosis
  • Jun Xia
  • Sai Zhao
  • Roderick Hay

CRG team:

• Finola Delamere
• Liz Doney
• Laura Prescott
• Hywel Williams

For more information

Email Nuala Livingstone, Cochrane Editorial Unit

Maja Boban recently used TaskExchange to get some help with her Cochrane review, and we thought you might like to hear how it worked out.

Maja is a psychologist and a Senior Advisor in HTA at the Agency for Quality and Accreditation in Health Care and Social Welfare in Croatia. Hi Maja!

Maja was working on a review of multimedia-delivered cognitive behavioural therapy for depression in adults. Pretty interesting and important topic. But Maja only had one co-author on the review, and needed more team members.

Looking for help, Maja contacted the Common Mental Disorders Group and asked if they could recommend anyone to join her team. They suggested she post her request on TaskExchange.

Brilliant plan, Common Mental Disorders Group, kudos to you!

So Maja did. She posted a task that beautifullly described her review and the kind of help she needed. She said she was looking for people with expertise in psychiatry and psychology to join her team and she was happy to make them co-authors on the review.

Then things got interesting.  

Maja says in just a “few weeks 3 persons (from USA, India and Greece) contacted me and now we have a great (multidisciplinary and multicultural) team for our review”.

How awesome is that? Answer: very.

And that’s how TaskExchange works. You describe the help you need, and kind, smart people offer to help you out.

So thanks Maja for sharing your story, and good luck to you and your new team. We look forward to seeing your review!

Find out more

Check out the latest TaskExchange activity below.

Head to taskexchange.cochrane.org, post a task or two, help someone out, or just marvel at how cool, intelligent and generous this community is. 

Send us your stories of using TaskExchange and suggestions about how we can make TaskExchange better meet your needs. It’s all about you, folks. And the reviews, oh yes, the reviews.

Tari Turner

on behalf of the TaskExchange team

taskexchange@cochrane.org

Support for Project Transform was provided by Cochrane and the National Health and Medical Research Council of Australia (APP1114605). The contents of the published material are solely the responsibility of the Administering Institution, a Participating Institution or individual authors and do not reflect the views of the NHMRC.

The Cochrane-Wikipedia partnership started in 2014 with the aim of improving the evidence base of Wikipedia articles using Cochrane Reviews and other relevant evidence. We are delighted to announce the launch of the Cochrane-Wikipedia Initiative pages on Wikimedia as the go-to place for all Cochrane-Wikipedia projects and related resources. Groups and contributors in both organizations are carrying out innovative projects in support of the partnership, and you can find more information about these and related resources there; here we share an update from one.

Clive Adams, Co-ordinating Editor of the Cochrane Schizophrenia Group, and Douglas White, medical student, carried out a research project to assess what proportion of Cochrane Reviews are ‘Wiki-compatible’. Read on for an update on what they found out.

Wikipedia is accessed every day by people from all over the globe. Cochrane has recognised it as a key tool for dissemination of evidence and is working together with Wikipedia.

But…how many existing Wikipedia pages are suitable for insertion of evidence from any given Cochrane Review? Just as all Cochrane Reviews would potentially fit into a page focused on ‘health care’, all Cochrane Schizophrenia Group (CSG) reviews could fit into a page on ‘management of schizophrenia’. However, such seeding of general pages with huge amounts of evidence would defeat the goal of providing succinct information.

We investigated how many of the 200 CSG reviews would have a Wikipedia page that is both specific and appropriate upon which to ‘land’.  Reviews with relevant but less appropriate Wikipedia pages – in which, for example, the intervention was mentioned but only briefly among others – were also identified, as well as reviews with no obvious Wikipedia page.

Out of 200 reviews, 97 (49%) had an obvious Wikipedia ‘landing’ page and a further 47 (24%) were associated with a page that was of potential relevance but was less appropriate. 56 (28%) reviews had no obvious Wikipedia ‘home’. Of the 144 (72%) CSG reviews with at least a potential Wikipedia ‘landing’ site, 76 (53%) had Summary of Findings table(s), which can be a source of succinct evidence for a new Wiki-compatible table.

Creating brand-new pages for the 61 ‘homeless’ reviews would be time consuming.  Expanding or creating a new page for the 47 reviews with a relevant, but not necessarily appropriate, existing ‘landing’ would require less work. Using the Summary of Findings data, entirely rewriting and formatting for the wider readership of Wikipedia takes a little time – but not much. Many of Cochrane’s Reviews are Wiki-compatible right now. 

Do you have a Cochrane-Wikipedia project or other relevant resources that you think we should share? Please let us know!

Cochrane contributor Matthew Page, working with an international team of research colleagues, has recently completed an examination of the current quality and quantity of systematic reviews being published. A report of the study published in the online journal Public Library of Science (PLoS) Medicine on 24 May, and Cochrane Senior Editor Toby Lasserson asked Matthew for some more details about the scope, methods, and findings of the study.

TL: Can you tell us a bit about the study that you undertook? What were you comparing?

MP: We performed a cross-sectional study to find out how many systematic reviews of biomedical research are being published, what questions they are addressing (e.g. therapeutic efficacy or diagnostic test accuracy or prognosis), and how well the methods and results are reported. This was a 10-year update of a landmark study by Moher and colleagues published in PLoS Medicine in 2007, which summarized the characteristics of a 2004 sample of reviews. We looked for all systematic reviews added to MEDLINE during one month (February 2014), and recorded the characteristics of these reviews. We wanted to know how the frequency and quality of systematic reviews has changed over the decade, and whether reporting quality is associated with being a Cochrane Review and self-reported use of the PRISMA Statement.

TL: You identified 682 systematic reviews in doing this study. How did you assess their quality?  

MP: We assessed the quality of systematic reviews using a standardized data collection form which includes 88 items. The items were influenced by PRISMA and MECIR, and addressed all components of the systematic review process, including reporting of eligibility criteria, search methods, risk of bias assessment, statistical analyses employed, and details such as funding and conflicts of interest. We captured not only whether a method was reported, but also which specific method was used (e.g. rather than just recording whether risk of bias was assessed, we recorded how many authors were involved in the assessment, and which risk of bias tool was used).

TL: One of the interesting findings is the increase in the number of systematic reviews published. Roughly how many more are being published now, and why do you think that they are more common?  

MP: Compared to the 2004 sample, we found a more than threefold increase in the production of systematic reviews indexed in MEDLINE - from about 2,500 systematic reviews in 2004 to more than 8,000 in 2014. I think there are many possible reasons for the increase. For example, the scientific community and healthcare providers may have increasingly recognized the need to integrate the massive amount of published research in a systematic way; and some funding agencies now require applicants to perform a systematic review to justify their proposal. But also, the proliferation of journals means that authors can more successfully submit a systematic review for publication - regardless of whether another one on the same topic has already been published elsewhere. So there is a big problem of overlapping reviews in the literature.

TL: So, there are more systematic reviews around now - but have they got better overall?

MP: In some ways, yes, but in many other ways, no. It was really encouraging to see that more review authors are summarizing the results of their literature searches in a PRISMA flow diagram, and recording the reasons for excluding studies. However, many important aspects of the process -  defining a primary outcome, presenting a full Boolean search strategy, assessing harms in intervention reviews, declaring the funding source for the review - were either reported less frequently or only slightly more frequently in the 2014 sample. So there is much more work to be done to increase transparency of systematic reviews.

TL: There are more guidelines on systematic review production and reporting now than there were in 2004. How far do you think researchers are adhering to guidance from initiatives like MECIR and PRISMA? 

MP: Only 29% of authors explicitly stated that they used the PRISMA Statement to guide either the conduct or reporting of their review. It’s encouraging to note that we found that authors who stated that they used PRISMA reported their reviews more completely than authors who did not. So I think reporting guidelines have had some impact on the systematic review community, but there is definitely room to improve adherence.

TL: One of the key differences for Cochrane is how our reviews compare with their non-Cochrane counterparts. What sort of differences were there both in terms of their features and their quality?

MP: Cochrane Reviews differed to their non-Cochrane counterparts in numerous ways. On average, Cochrane Reviews include fewer studies, and restrict eligibility to randomized trials more often, rather than including non-randomized studies of interventions (NRSI). I suspect that this latter aspect may change with the recent launch of the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool, which provides review authors with a way to highlight a wide range of risks of biases in NRSI in a comprehensive way.

Reporting in Cochrane Reviews also happens to be much more complete when compared with non-Cochrane Reviews. I think this greater transparency has been influenced by a number of Cochrane-led initiatives, such as MECIR and the standard RevMan template. As an active Cochrane reviewer, I have found the RevMan template invaluable in prompting me to document all components of the systematic review process!

TL: Based on your study, what are the most important areas where systematic reviews need to improve, and how might we achieve that?

MP: Systematic reviews can improve in a number of ways. There could be more detailed reporting of the search strategies used, methods of data extraction and risk of bias assessment, and funding sources. Risk of bias or study limitations need to be considered more often when reaching conclusions. And there should be much greater use of trials registers such as ClinicalTrials.gov and other sources of unpublished data, to address the problem of reporting bias, which is too often ignored.

I think that in order to address poor reporting of systematic reviews, we need to move towards strategies other than passively disseminating reporting guidelines in journals. Some promising options include developing software to facilitate completeness of reporting, and having journal editors and peer reviewers receive certified training in how to implement reporting guidelines.

TL: As editors we have a particularly important role in assuring quality of published systematic reviews. What sort of insights does your study provide about what we do well and where we need to improve?  

MP: I think that journal editors who actively endorse and implement reporting guidelines such as PRISMA or MECIR tend to produce more completely reported reviews. However, as a journal editor myself, I recognize the large amount of (often voluntary) time that goes into such work. Therefore, I think we as editors need to engage with the tech community to develop tech solutions to facilitate these processes. Start-up companies such as Penelope, which is developing a web tool to check manuscripts automatically for missing information, particularly excite me!

What is the Targeted Update Project?
Supported by the Cochrane Steering Group, this pilot project was conducted jointly by the Cochrane Editorial Unit and Cochrane Innovations, and involving Cochrane Review Groups (CRGs). This project aimed to provide policy-makers, in particular guideline developers, with up-to-date information from Cochrane Reviews, tailored to their needs and in a fast timeline.  Targeted Updates are targeted two-page documents that use Cochrane Review as their foundation, but focus on updating only one or two important comparisons, and the seven most relevant outcomes. The final choice of comparisons and outcomes are made in consultation with a group of content experts, often including the original review authors, the CRG editorial team, and guideline developers. They include an updated ‘Summary of Findings’ table and a detailed plain language abstract. The search results, risk of bias assessments, analyses and references are made available as supplementary information, as they do not form part of the Targeted Update document itself. Although Targeted Updates are not Cochrane Review updates, Cochrane methods are used to produce them so that any new data can then be used by review authors to facilitate a full Cochrane Review update where appropriate.

What we planned
With this in mind, we planned to work with four volunteer CRGs to produce 16 Targeted Updates. These groups had different types of relationships with guideline developers, which reflects Cochrane as a whole. Our initial discussion with guideline developers and the project advisory group helped us to identify necessary and useful changes in the project.

What we did
Over the course of this project, we have worked with seven CRGs and four guideline developers. We developed 13 Targeted Update documents working with these seven groups, often in partnership with guideline developers. Most Targeted Updates took 2-8 weeks to produce. While the Targeted Update team took primary responsibility for overseeing the process in its entirety, as well as its final output, the CRGs were given the option of participating in all aspects of the process, to whichever level they were able to commit.

What we produced
The final Targeted Update documents are now being made publically available online via a series of posts here on the Cochrane Blog. Targeted Update documents which were specifically requested by guideline developers were also sent to the relevant organizations. 

Coming soon, we will be publishing case studies and examples of the Targeted Update documents we produced through the project. We would welcome any comments or feedback you may have, on any of the upcoming case studies, or the project in general (contact details below).

What happens next
While this was a pilot project, we do hope that the project may continue in some form in the future, and are currently working to develop this future implementation plan in more detail. If you are interested in learning more about the Targeted Update project, or would like to discuss any potential future collaborations, feel free to get in touch.

For more information

Please contact Nuala Livingstone, Quality Editor, Cochrane Editorial Unit

Tracey Perez Koehlmoos is Director of the Health Services Administration Division and Associate Professor of Preventive Medicine & Biostatistics at the US Uniformed Services University of the Health Sciences. She is also a Cochrane Review author, member of the Cochrane Library Oversight Commitee, and contributor to the work of the Campbell and Cochrane Equity Methods Group. Here she talks about her experience of publishing an ‘empty’ review – and the impact of doing so.

It was not the review we had planned. When the team and I first travelled to Geneva in 2007 for training at WHO in the conduct of systematic reviews, we wanted to set the world on fire. In our grant proposal to the Alliance for Health Policy & Systems Research, we had committed to answering pressing questions about the role of the non-state sector in health systems in low- and middle-income countries. We left with a great mentor, Prof. Sandy Oliver, and a burning desire to know: The Effect of Social Franchising on Access to and Quality of Health Services in Low and Middle Income Countries (Koehlmoos 2009).  

After an arduous proposal development process; a screening of the literature that left with me a permanent occupational injury in my mouse-dragging hand; and a tremendous amount of back-and-forth correspondence with the EPPI Centre and the EPOC group; two years later we’d finished the ritualistic dance that meant I was married to this topic until I die or retire. I produced a review that said nothing. OK, not really nothing, but no included studies so just a resounding conclusion that “more research is needed, and this is what it should look like.” Certainly, as scientists when we embark on a journey of discovery, we hate to come away empty handed. Further, all Cochrane discussions on the prevention of empty reviews have stung me for years in a very personal way—as if it was my fault that despite the international hope and brouhaha around the intervention, the literature was immature and I should have known better rather than waste everyone’s time and resources. Further supporters of the intervention were disappointed with my results and held the lack of evidence with disbelief—the problem was with me, I did not dig hard enough or far enough to prove that the good idea worked.

So, what happened? My little empty review took on a secret life of its own. I had clearly stated what needed to happen next in the Implications for Research section of the review, calling for high-quality impact evaluations of the intervention. Then, a number of things happened. The team and I conducted a second systematic review of social franchising with more permissive inclusion criteria and more qualitative analysis that is now published in the EPPI Centre library (Koehlmoos 2011). It provided a platform to discuss the literature that already existed.

Also, we took the lack of rigorous evaluation public by speaking at conferences and in the press through articles in casual places like the ELDIS Health Systems Reporter. The review became included in the Health Systems Evidence database. The lack of evidence for this non-state sector intervention became a topic of discussion at numerous research planning meetings, and was used to generate research funds to test the intervention.

Equipped with an intimate knowledge of the intervention, I became a member of an advisory panel for the largest social franchise in Bangladesh. We supported the completion of a SUPPORT summary on social franchising. The experience of using two different synthesis methods to cover this topic was included in a book on systematic reviews. I watched as primary research studies on social franchising took to the field. As of today in Harzing’s Publish or Perish reminds me that the empty little review now has 39 citations.

I have continued to watch the literature with a standing search of PUBMED so that every Saturday I am updated on publications about social franchising. I have been under pressure to update the review but have not felt that the literature was ready to make the effort worth the resources. In 2011 my life imploded when my husband died in a road traffic crash—and I had to give up my scientific leadership position and research portfolio in Bangladesh as I repatriated unexpectedly to the US. I found myself working for the US Marine Corps—and focusing on the health systems and research needs of Marines and their families. Recently I returned to academia as a professor at the military’s medical school, the Uniformed Services University of the Health Sciences (USU, conveniently located across the street from the NIH). I miss working and living in South Asia and engaging in global development and with international scientists.

Last month in my USU inbox was an unexpected email from an unknown researcher at a US university, “Dear Dr. Koehlmoos, I wanted to update you about my social franchising research…” He went on to say that he has two papers under review. Of course I asked, “Does it work?”, but we will have to wait for the updated systematic review to know for certain. Empty reviews not worth the effort? I strongly disagree.

The opinions expressed in this article are Tracey's own and in no way reflect the opinions of the US Marine Corps, the Uniformed Services University of the Health Sciences, the Department of Defense, or any other agency.

Today marks a new chapter in the Cochrane Embase project with the launch of the beta version of Cochrane Crowd. The Cochrane Embase project has been a huge success. To date, some 2,414 contributors have screened 304,499 records and identified 22,448 reports of randomized trials, with 99% sensitivity and specificity based on the latest evaluation. The project has been led from the outset by an inspiring and dedicated team.

The Embase project has helped Cochrane in many ways. The first is the most obvious: that it provided a model that enabled Cochrane to identify reports of randomized and quasi-randomized trials to feed into Cochrane’s Central Register of Controlled Trials (CENTRAL), so that they could then be appraised for inclusion in our systematic reviews.

The second successful outcome has been the way the project enabled people to contribute to Cochrane who wanted to but previously had not been able to find an accessible entry point. Over the past two years, the project team has been humbled to receive many emails from contributors thanking them for the opportunity to help Cochrane. As they are the first to say, it is the contributors we are grateful to. Without the fantastic support they have provided, as with all our contributors to Cochrane’s work, the task of brokering and synthesizing health information would be so much harder. We have been particularly pleased to note the geographic diversity of those contributing to the project, with many coming from lower- and middle-income countries.

The third benefit has been that the project has introduced new methods for handling the ‘information overload’. We have learned so much from the Embase project that went beyond the immediate task of identifying trials for CENTRAL. We learned that it is possible to take a small but vital task, and have it performed to an extremely high quality, by a community of people who may not have had any previous experience with evidence production. We learned that together we can capture, curate, and classify the evidence as it is produced and published. This is truly exciting, it means that finally, after years of struggling to keep up, we stand a chance of being able to respond quickly to important questions of clinical effectiveness.

In the future, records will come from a range of sources, some of which will be freely accessible, including those from ClinicalTrials.gov and PubMed. Some of our sources, however, are and will be proprietary databases. Within the Embase project, and now on Cochrane Crowd, we are working on records that have been sourced from Embase. Embase is owned by Elsevier, a for-profit publisher with whom our publisher Wiley has a contract that enables us to access and re-publish those records in CENTRAL. Wherever possible we will seek to share the records identified by the community, with as wide an audience as possible, within a framework that acknowledges the legal rights of database providers.

This week is an important and proud one for Cochrane, as it sees the transfer of the Embase project into the newly launched beta Cochrane Crowd platform - an environment that moves well beyond simply classifying studies from Embase to a new world of crowdsourcing as a key strategy aimed at providing entry routes into Cochrane and its work. We also expect that crowdsourcing, combined with changes in our editorial processes, and the huge investments Cochrane is making in new technology, will help us to achieve the substantial efficiency gains in review production that many, inside and outside our community, would like to see. We recognize that transparency is critical: we will ensure that no one who contributes to our work through the Cochrane Crowd platform is in any doubt about the importance of the work or the way that it is used to develop our products and services, all of which are aimed at improving health-care decision-making.

Cochrane contributors seek to promote the common good – that has been the secret of our success. As the correspondence to the team demonstrates, the Embase project has attracted individuals who otherwise have been unable to find a way to contribute to Cochrane. We celebrate the extraordinary work that the team have accomplished so far, and we welcome the next step of our journey. We hope you will join us at Cochrane Crowd

Please note that a version of this blog has been posted on the EVIDENCE-BASED HEALTH listserv.
 

David Tovey
Editor in Chief, Cochrane Library

Mark Wilson
CEO, Cochrane

Julie Wood
Head of Communications and External Affairs, Cochrane

Chris Mavergames
Head of Informatics and Knowledge Management, Cochrane

12 May 2016

Support for Project Transform was provided by Cochrane and the National Health and Medical Research Council of Australia (APP1114605). The contents of the published material are solely the responsibility of the Administering Institution, a Participating Institution or individual authors and do not reflect the views of the NHMRC.

This Cochrane Blog post highlights the contributions of Professor Rhoda Redulla, a significant contributor to Cochrane Nursing Care.

Professor Rhoda Redulla has been an active member of the Cochrane Nursing Care Field (CNCF) for several years and has prepared numerous Cochrane Review Summaries that have been published in many highly regarded collaborating journals, including the International Journal of Nursing Studies, the International Journal of Older People Nursing, the Nursing Times, and the International Journal of Evidence Based Healthcare. Professor Rhoda Redulla is the Director of Education, Memorial Hospital of Salem County, New Jersey, USA and an Adjunct Nursing Professor at the Drexel University Pennsylvania.  With almost twenty years of combined professional nursing experience, Rhoda offers a valuable and practiced perspective to the Cochrane Review Summary. 

Rhoda started her career as a Nursing Professor at the University of Northern Philippines and pursued her master’s degree right after completion of her baccalaureate nursing program. This sparked the beginning of her love for research as she worked to learn more about the care of low birth weight babies.  She also continued to pursue her Doctor of Philosophy in Nursing.  Midway through the program, Rhoda’s family moved to the United States of America where she relaunch her nursing career.  Rhoda’s experience working as a clinical nurse at the Gastroenterology and Hepatology Division of the Hospital of the University of Pennsylvania nurtured her interest in chronic liver disease. When Rhoda pursued her Doctor of Nursing Practice degree, a clinical-focused doctorate at the Johns Hopkins University, her project focused on developing and testing a nurse-driven pathway in hepatitis C management. Her academic program was designed to foster both clinical and scientific inquiry and here she learned to conduct a systematic review. She is also actively involved in her professional nursing organization, Society of Gastroenterology Nurses and Associates (SGNA).  In 2012, the organization launched a scholars’ program and partnered with the Joanna Briggs Institute (JBI- Texas Christian University Collaborating Centre). This was part of SGNA’s strategic plan to train more gastroenterology and endoscopy nurses in evidence-based practice. Rhoda was one of the eight scholars in the inaugural class and obtained certification in JBI Comprehensive Systematic Review. During this time, Rhoda also assumed a new role in her organization as the Magnet Program Director and Director of Nursing Practice, tasked with advancing professional nursing practice through evidence-based practice. She was also the nursing liaison to the Centre of Evidence-Based Practice, University of Pennsylvania Health System. In this role, Rhoda deepened her knowledge in evaluating clinical issues from various areas in the organization, defining scope of key question and outcomes. She values professional advancement and feels grateful to have the opportunity to practice at the highest levels of nursing through leadership and scholarship. She has published in peer-reviewed journals and is an expert reviewer for several professional nursing journals.  

Rhoda’s commitment to advancing the knowledge and skills of nurses in evidence based practice prompted her to become involved with CNCF as an evidence summary writer.  Rhoda writes, “At the patient’s bedside, nurses are constantly confronted with clinical issues and expected to think and act quickly, yet effectively and most efficiently. For example, the use of CHG vs soap and water and the effect to surgical site infection, strategies in educating patients to improve medication adherence, nurse bedside shift report and hospital-acquired complications – these questions arise in daily practice. Empowering nurses to learn how to access the most current and best evidence can lead to measurable improvements in healthcare quality and patient safety.  After conducting that first systematic review several years ago, my mindset on how I view research and evidence was completely transformed. The CNCF plays a vital role in the dissemination of best practice evidence related directly to frontline care, and provides critical information that nursing staff can access and absorb quickly and easily.” 

Thank you for your valuable contributions, Rhoda!

Would your Cochrane Group like to tell the community about a beloved contributor? Email mumoquit@cochrane.org

Susi Wisniewski is former Managing Editor of the Cochrane Dementia and Cognitive Improvement Group and Programme Manager for Cochrane Screening and Diagnostic Tests Methods Group. She remains involved with Cochrane as an author, particularly on Diagnostic Test Accuracy reviews. Since leaving her full-time role within Cochrane, Susi has launched a mobile phone app called TripLinks, which is aimed at improving business travel. Here she explains what it's all about and why it might just come in useful for your next trip or Colloquium.

The idea of TripLinks was born on my first solo transatlantic business trip: at the time I was mid-twenties and working for a global publishing company. I attended a conference in Montreal during the Jazz Festival. I was so excited by the prospect of visiting one of the world’s most vibrant and multicultural cities. But when I got there the reality didn’t quite measure up. At the end of my working day, I wanted to experience the city and decided to go for a drink, but it was pretty intimidating sitting in a bar on my own. So rather than go back to my hotel room and accept defeat, I went to the cinema. To see Shrek. In French.

I’m generally pretty fearless when it comes to chatting to people in the right context like a conference or a networking event, but when I’m out “in the wild”, I lose my nerve.

Friends and colleagues felt the same, we used to joke “there must be an app for that” but there wasn’t...

Then I came to work for Cochrane. Although I was quite new to the Collaboration when I attended my first Colloquium (in Singapore), I was very lucky; I was a Managing Editor, and being based in Oxford (at the time very much the capital city of Cochrane) I had already had a chance to meet up for drinks with some of my Cochrane colleagues. The Colloquium was a fabulous experience! Meeting new people, chatting, and getting out to see the city; this is what my business travel had missed before!

The theme of a business travel revolution was one I often thought of; I did some reading around & found that a heavy schedule of business travel was often associated with higher BMI, higher levels of stress, and emotional isolation.

Business travellers are often away from their family & friends...life ticks on back at home, but staying in a city where you know nobody gives the curious feeling of being in limbo.

I chatted to friends and colleagues who revealed that they'd often have a busy day of meetings then continue working in their rooms until bedtime to stay occupied. A sure path to burn-out! Others had more free time but not much to fill it.

Even those who ventured-out felt it could be improved; I have a vivid and surreal memory of a trolley-bus tour of the Freedom Trail in Boston. I was on my own but determined to take in the famous sights. My memories of that day are more like memories of watching a documentary; something about the fact that I had nobody to talk to means that my brain has stored it in a different file!

How could I improve this situation? It seemed to me that a glance around any busy hotel restaurant on a week night gave the answer: typically four or five tables-for-one; lone business travellers with a laptop, or checking their phone, perhaps reading the paper. What if we could get these people together? What stories would they tell each other? Perhaps they would discover a shared interest in architecture and book onto a walking tour together; maybe they'd be fellow football fans and find a bar showing that night's game. Whatever they did, I was sure that it would be more fun and fulfilling than sitting alone!

The idea for TripLinks grew until I took action, late in 2014, working with the Serious Games Studio at Coventry University to develop the wire frame for the concept. From here, we were able to secure a small European Grant to develop the app and we launched in November 2015.

The app is simple: you say where you'll be, what you want to do and when. You can use these parameters to search for events nearby to join, or to create your own invitation for others.

TripLinks is strictly platonic; with very limited profile information, it’s definitely not a dating tool; it’s not really even about networking...just a way to find someone to hang out with for a couple of hours when you’re away from home.

We hope that TripLinks will improve lives; helping business travellers to reclaim a sense of self and find a work-life blend to suit them.  By encouraging meetings between people who wouldn’t ordinarily meet, we hope to provide enlightening, mind-opening experiences. The great thing is, that as we’ve launched the app, people have started using it when they’re at home, too! Perhaps their partner is away and they’re at a loose end; perhaps they’ve moved to a new area and don’t know many people; perhaps they want to practice their language skills; the possibilities seems to be endless.

We're currently trying to grow the TripLinks community; our aim is to share with as many people as possible – perhaps download for the upcoming Colloquium!

TripLinks is free to download and use and is available in the App Store and Play Store.

Registration for the 25^th Colloquium in Seoul, Korea, 23-27 October, is now open!

It was a pleasure to see and work with many of you at the mid-year business meetings in London from 4-5 April, which were followed by three days of Cochrane Steering Group (CSG) meetings. My impression is that we will look back on those meetings in London as some of the most significant in Cochrane’s history, when the organization’s leaders made critically important decisions on how we work together and are structured as an international network of Groups; and how we oversee and govern our affairs.

Strategy to 2020 aims to put Cochrane evidence at the heart of health decision-making all over the world. To achieve this we need to do two things: first, make it simpler, quicker, and more efficient to produce high-quality Cochrane Reviews. Second, increase the number of people worldwide accessing and using Cochrane evidence in their decision-making. We have already taken significant steps along this road, making substantial investments in improving the technology author teams use to produce reviews via initiatives such as Project Transform and the Cochrane Author Support Tool. We have launched an integrated quality strategy comprising prioritization, quality management and assurance, quality improvement, editorial and methods policy development, and maintenance. We are working with Wiley, our publisher, to deliver an enhanced Cochrane Library in early 2017 that is built around the priorities identified through user research. We are expanding our training and translation activities worldwide. And we are forming partnerships with organizations that can help us deliver and disseminate our work.

But alongside all of that progress, the CSG has recognized that in order for us to achieve our strategic goals, Cochrane needs to change its structure and ways of working in a more fundamental way than it has ever attempted before. We are still organized along the design developed by the original founders of the collaboration whilst we are working now in a very different world. Groups are under increasing pressure to maintain their funding from governments, research institutions, and other non-commercial sources in a climate of decreasing investment in research where donors are demanding greater value for money and greater evidence of impact. This financial pressure is coupled with increasing workloads as Cochrane Reviews grow in scope and complexity and the number of new contributors wanting to produce Cochrane Reviews rises inexorably, whilst the number of high-quality reviews published in other competitive journals also increases. 

To me it is self-evident that rationalizing and securing our global network of Groups is not only vital to organizational sustainability, but also to our whole aim of producing high-quality, accessible evidence. You have been able to read about the proposals for the Structure and Function project in an email sent last week to all Groups and also made available on our Community site, so I won’t repeat the details here, but I would like to use this opportunity to summarize some of the thinking behind the plans:

• New approaches to editorial processing, including elements of centralization and separation of editorial and developmental roles, will make it simpler and faster to produce Cochrane Reviews and help us to make the Cochrane Library the publisher of choice for the highest quality systematic reviews.
• Our current organizational structure is too complex, and it makes contributing to Cochrane and producing and disseminating our evidence more difficult and inefficient than it needs to be. A model based on topic and geographic networks will make it easier to organize internal resources more efficiently, and communicate to the outside world about how we operate and what we produce. 
• Groups want greater flexibility in what they do for Cochrane to allow them to use their expertise most effectively and also to respond to their funders’ priorities. The introduction of modular functions will allow this; and our organizational structure will be an enabler, not a barrier, to contributing to our work.  

The CSG has provided a mandate for this change – we have a desired destination and now we need to work out how to get there. Members of the Central Executive Team will be working with collaborators from across all parts of Cochrane to refine, evaluate, and improve the proposals over the coming months. The consultations will start in a few weeks, and will include multiple webinars and other opportunities aimed to ensure an inclusive process, particularly in relation to geographic and linguistic diversity. The forthcoming Colloquium in Seoul, which is aptly focussing on how Cochrane can respond to its challenges, will provide a key opportunity for input.

Alongside the main Structure and Function project, there are two other initiatives this year that are playing an immediate and significant role in our goal of building an effective and sustainable organization: governance reform and the launch of Cochrane’s membership scheme. 

The CSG announced earlier this year a proposal to move to a new governance structure, including development of a new Cochrane Governing Board following  a review of governance that the Steering Group completed last year. Full details of the proposal are available on the Cochrane Community site. At the strategic session in London, participants focussed on ensuring a meaningful voice for Groups in the new governance structure. This is likely to be achieved through the development of a ‘Council’ that will incorporate members of the Group Executives and Boards. The CSG’s Governance Reform Working Group is now assessing and developing the recommendations made by the participants in London and will provide a detailed proposal for consultation and eventual ratification at the forthcoming AGM in Seoul.

The introduction of a membership scheme for Cochrane will also be transformational: allowing us to greatly expand our overall capacity, the number of active supporters and members able to be involved in our work, and – we hope - creating a better experience for newcomers, all without adding to Group staff workloads. Membership will make it possible for anyone to ‘join’ Cochrane, so that being part of the organization is no longer limited to writing reviews. New clear pathways will be developed so that anyone can get involved with a task that is suitable for them. The scheme will be officially launched at the Seoul Colloquium and in the meantime, you can read about progress on the Cochrane community site. 

Nobody should fear that this new phase of organizational change is a way of reducing human resources. Cochrane is growing rapidly, and we are moving towards a structure that is better able to support and manage that growth, building upon many examples of excellence and providing opportunities for increasing Groups' capacity to identify their own solutions. At the Cochrane Group level we want to implement more efficient editorial and production processes, and reduce duplication of effort, thereby increasing opportunities for new kinds of work. But let me be clear; we are an organization doing a huge job with a comparatively tiny number of staff: around 500 Group and Central Executive staff compared to more than 38,000 registered contributors. Whilst we might see the consolidation of activities and certain resources by Groups, we are not seeking a reduction in staff numbers  – that would be incredibly counter-productive. It is my firm belief that we are moving towards a model that promotes new opportunities and career development for individuals working within Cochrane, whilst at the same time addressing the challenges of working more efficiently and effectively together, increasing the value and the value for money of the evidence we produce; and therefore sustainability of the organization as a whole.

Mark Wilson, CEO (mwilson@cochrane.org, @MGW_Cochrane)